Provider Demographics
NPI:1124753298
Name:STROUP, GARRETT CORRIGAN
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:CORRIGAN
Last Name:STROUP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23451 N UMPQUA HWY
Mailing Address - Street 2:
Mailing Address - City:GLIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97443-0277
Mailing Address - Country:US
Mailing Address - Phone:815-978-6512
Mailing Address - Fax:
Practice Address - Street 1:23451 N UMPQUA HWY
Practice Address - Street 2:
Practice Address - City:GLIDE
Practice Address - State:OR
Practice Address - Zip Code:97443-0277
Practice Address - Country:US
Practice Address - Phone:815-978-6512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR634232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic