Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 62451 | OR |
NPI | 1205267754 |
---|---|
Provider Name | Carly Lochala |
First Address | New York, NY 10036-8102 |
Second Address | Portland, OR 97239-4501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2013 |
Last Update Date | 01/04/2020 |