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1174001887
LYNDSAY PROVENCIO
PORTLAND, OR
NPI
1174001887
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: OR 62930)
Enumeration Date
2018-08-03
Last Update Date
2018-09-20
Business Address
LYNDSAY PROVENCIO PT
4829 NE MLK JR BLVD STE 101
PORTLAND, OR 97211-3491
Phone number: 503-283-8133
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Mailing Address
LYNDSAY PROVENCIO PT
16083 SW UPPER BOONES FERRY RD STE 300
TIGARD, OR 97224-7736
Phone number: 503-443-6156
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