| NPI | 1164637641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY ALLEN DAVIS Administrator 503-728-0424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 0713) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 200450118NP) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: OR 000038358N2) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-08-22 |