Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 6169 | OR |
NPI | 1255654307 |
---|---|
Provider Name | Jeffrey Alan Richter |
First Address | Portland, OR 97223-5503 |
Second Address | Portland, OR 97223-5503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2010 |
Last Update Date | 03/03/2010 |