Provider Demographics
NPI:1740219500
Name:SOSTRIN, ISRAEL (PT)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:SOSTRIN
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:PO BOX 10602
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97296-0602
Mailing Address - Country:US
Mailing Address - Phone:503-327-4756
Mailing Address - Fax:503-231-6605
Practice Address - Street 1:5909 SE DIVISION ST STE 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-1470
Practice Address - Country:US
Practice Address - Phone:503-231-3633
Practice Address - Fax:503-305-4752
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR858185000OtherBCBSO
OR611036100OtherUS DOL (ACS FISCAL AGENT
OR3080245-01OtherFC65, PC65, M/C ADV PPO
OR9317339OtherPHCS
OR9317339OtherPHCS