MEDICARE: ANDREW GRANT ROBERTSON

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	65668	OR
2	225100000X	Physical Therapist	070023337	IL
3	225100000X	Physical Therapist	070.02337	IL

General Provider Information

NPI Number	:	1710496344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW GRANT ROBERTSON

Provider Business Mailing Address
First Line	:	3934 NE MARTIN LUTHER KING BLVD
Second Line	:	SUITE 203
City	:	PORTLAND
State	:	OR
Zip	:	97212
Country	:	US
Telephone Number	:	503-223-1856
Fax Number	:	503-223-1765

Provider Business Practice Location Address
First Line	:	3934 NE MARTIN LUTHER KING BLVD
Second Line	:	SUITE 203
City	:	PORTLAND
State	:	OR
Zip	:	97212
Country	:	US
Telephone Number	:	503-223-1856
Fax Number	:	503-223-1765

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

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	02/05/2026

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Directions to “ ANDREW GRANT ROBERTSON ” Practice Location

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