Provider Demographics
NPI:1932671302
Name:MARCANO, AMADOR ANTONIO III (PT)
Entity Type:Individual
Prefix:DR
First Name:AMADOR
Middle Name:ANTONIO
Last Name:MARCANO
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:336 LIVINGOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-5957
Mailing Address - Country:US
Mailing Address - Phone:503-572-8309
Mailing Address - Fax:
Practice Address - Street 1:19201 SE DIVISION ST STE 100
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5333
Practice Address - Country:US
Practice Address - Phone:503-405-8235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic