Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 60884 | OR |
NPI | 1003205436 |
---|---|
Provider Name | Amanda L Swearingen |
First Address | Portland, OR 97205-1916 |
Second Address | Portland, OR 97205-1916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2015 |
Last Update Date | 04/01/2019 |