Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 3774 | OR |
NPI | 1033535315 |
---|---|
Provider Name | Marie Pielage |
First Address | Hillsboro, OR 97123-4246 |
Second Address | Hillsboro, OR 97123-4246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2014 |
Last Update Date | 11/03/2014 |