MEDICARE: CRAIG PLUMMER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3913	OR

General Provider Information

NPI Number	:	1205997681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG PLUMMER PT

Provider Business Mailing Address
First Line	:	24900 SE STARK ST
Second Line	:	SUITE 106
City	:	GRESHAM
State	:	OR
Zip	:	97030-3355
Country	:	US
Telephone Number	:	503-413-3879
Fax Number	:	503-413-4379

Provider Business Practice Location Address
First Line	:	24900 SE STARK ST
Second Line	:	SUITE 106
City	:	GRESHAM
State	:	OR
Zip	:	97030-3355
Country	:	US
Telephone Number	:	503-413-3879
Fax Number	:	503-413-4379

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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Directions to “ CRAIG PLUMMER PT” Practice Location

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