Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 3042 | OR |
NPI | 1073642922 |
---|---|
Provider Name | Elizabeth Shirley |
First Address | Salem, OR 97304-1341 |
Second Address | Salem, OR 97304-1341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 12/05/2010 |