Provider Demographics
NPI:1275842551
Name:GAMMARU, RAUL AGGABAO JR (PT)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:AGGABAO
Last Name:GAMMARU
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 TEAKWOOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-1344
Mailing Address - Country:US
Mailing Address - Phone:503-684-0311
Mailing Address - Fax:503-689-8088
Practice Address - Street 1:2216 TEAKWOOD AVE NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-1344
Practice Address - Country:US
Practice Address - Phone:503-684-0311
Practice Address - Fax:503-689-8088
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist