Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 61656 | OR |
N | 2251X0800X | Physical Therapist - Orthopedic | 2318PT | MT |
NPI | 1013237718 |
---|---|
Provider Name | Dr. Travis Michael Obermire |
First Address | Corvallis, OR 97339-1189 |
Second Address | Corvallis, OR 97331-8629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2010 |
Last Update Date | 04/02/2021 |