MEDICARE: ISRAEL SOSTRIN 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	4725	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	858185000	OTHER	OR	BCBSO
2	611036100	OTHER	OR	US DOL (ACS FISCAL AGENT
3	3080245-01	OTHER	OR	FC65, PC65, M/C ADV PPO
4	9317339	OTHER	OR	PHCS

General Provider Information

NPI Number	:	1740219500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISRAEL SOSTRIN PT

Provider Business Mailing Address
First Line	:	PO BOX 10602
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97296-0602
Country	:	US
Telephone Number	:	503-327-4756
Fax Number	:	503-231-6605

Provider Business Practice Location Address
First Line	:	5909 SE DIVISION ST STE 3
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-1470
Country	:	US
Telephone Number	:	503-231-3633
Fax Number	:	503-305-4752

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	08/02/2023

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Directions to “ ISRAEL SOSTRIN PT” Practice Location

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