Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 070.018664 | IL |
Y | 2251N0400X | Physical Therapist - Neurology | 61988 | OR |
NPI | 1477830735 |
---|---|
Provider Name | Kathleen Therese Scanlan |
First Address | Portland, OR 97217-5252 |
Second Address | Portland, OR 97239-4501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2011 |
Last Update Date | 02/04/2020 |