Provider Demographics
NPI:1336972140
Name:GURDIEL, REALINO L JR (PT)
Entity type:Individual
Prefix:
First Name:REALINO
Middle Name:L
Last Name:GURDIEL
Suffix:JR
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 1:4900 SW GRIFFITH DR STE 261
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4648
Mailing Address - Country:US
Mailing Address - Phone:847-668-4494
Mailing Address - Fax:503-608-7718
Practice Address - Street 1:4900 SW GRIFFITH DR STE 261
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4648
Practice Address - Country:US
Practice Address - Phone:847-668-4494
Practice Address - Fax:503-608-7718
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist