Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 0707 | OR |
NPI | 1396911467 |
---|---|
Provider Name | Carol Schunk |
First Address | Bend, OR 97702-1981 |
Second Address | Bend, OR 97702-1981 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2008 |
Last Update Date | 07/05/2008 |