Provider Demographics
NPI:1114090123
Name:GRENIER, ANGELA AUDREEN (DPT, LMT)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:AUDREEN
Last Name:GRENIER
Suffix:
Gender:F
Credentials:DPT, LMT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:8414 SW BARBUR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4018
Mailing Address - Country:US
Mailing Address - Phone:503-245-2434
Mailing Address - Fax:503-452-5979
Practice Address - Street 1:8414 SW BARBUR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-4018
Practice Address - Country:US
Practice Address - Phone:503-245-2434
Practice Address - Fax:503-452-5979
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62427208100000X
OR11252174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No174400000XOther Service ProvidersSpecialist