Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 04543 | OR |
NPI | 1003175225 |
---|---|
Provider Name | Lori Mueller |
First Address | Corvallis, OR 97339-1189 |
Second Address | Corvallis, OR 97330-6173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2012 |
Last Update Date | 14/05/2021 |