MEDICARE: MS. MARY E GRAMLING 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	10076	WA
2	225100000X	Physical Therapist	4889	OR

General Provider Information

NPI Number	:	1518925510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY E GRAMLING PT

Provider Business Mailing Address
First Line	:	2734 SE 47TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-1547
Country	:	US
Telephone Number	:	503-318-0654
Fax Number	:

Provider Business Practice Location Address
First Line	:	2734 SE 47TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-1547
Country	:	US
Telephone Number	:	503-318-0654
Fax Number	:

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	04/13/2010

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