Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 61053 | OR |
NPI | 1295213478 |
---|---|
Provider Name | Megan Elizabeth Rennie |
First Address | Beaverton, OR 97003-7651 |
Second Address | Hillsboro, OR 97124-9212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2018 |
Last Update Date | 31/07/2018 |