Provider Demographics
NPI:1952386039
Name:GULSTINE, SCOTT M (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:GULSTINE
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:1630 SW MORRISON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1916
Mailing Address - Country:US
Mailing Address - Phone:503-227-7774
Mailing Address - Fax:503-277-7548
Practice Address - Street 1:1630 SW MORRISON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1916
Practice Address - Country:US
Practice Address - Phone:503-227-7774
Practice Address - Fax:503-227-7548
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2011-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OR34932251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR145774Medicare PIN