Basic Information
| Provider Information | |||||||||
| NPI: | 1194987107 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAPORT | ||||||||
| FirstName: | GIJSBERT | ||||||||
| MiddleName: | JEROEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4515 SUNNYSIDE RD SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973023928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033708284 | ||||||||
| FaxNumber: | 5035668595 | ||||||||
| Practice Location | |||||||||
| Address1: | 4515 SUNNYSIDE RD SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973023928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033708284 | ||||||||
| FaxNumber: | 5035668595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 06/30/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2803 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.