Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 61084 | OR |
NPI | 1629420534 |
---|---|
Provider Name | Courtney Lewis |
First Address | Portland, OR 97213-2236 |
Second Address | Portland, OR 97213-2236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2016 |
Last Update Date | 05/07/2016 |