Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 06173 | OR |
NPI | 1154802890 |
---|---|
Provider Name | Adam Paris |
First Address | Tigard, OR 97224-7259 |
Second Address | Tigard, OR 97224-7259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2018 |
Last Update Date | 21/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06173 | PT LICENSE (01) | OR |