Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 61736 | OR |
NPI | 1073961074 |
---|---|
Provider Name | Madelaine Williams |
First Address | Springfield, OR 97477-4113 |
Second Address | Springfield, OR 97477-4113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2016 |
Last Update Date | 31/05/2016 |