Provider Demographics
NPI:1437574548
Name:SLATER, GREG (PT)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:
Last Name:SLATER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 SW IDAHO TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-3353
Mailing Address - Country:US
Mailing Address - Phone:503-319-1660
Mailing Address - Fax:
Practice Address - Street 1:1200 NE 48TH AVE STE 700
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5020
Practice Address - Country:US
Practice Address - Phone:503-640-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist