Provider Demographics
NPI:1457987836
Name:GREWAL, GURLEEN K (MPT, PT)
Entity Type:Individual
Prefix:
First Name:GURLEEN
Middle Name:K
Last Name:GREWAL
Suffix:
Gender:F
Credentials:MPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NW IRVING ST APT 709
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2260
Mailing Address - Country:US
Mailing Address - Phone:503-701-4390
Mailing Address - Fax:503-974-2612
Practice Address - Street 1:402 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2907
Practice Address - Country:US
Practice Address - Phone:503-701-4390
Practice Address - Fax:503-974-2612
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63535208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation