Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 23764 | MD |
Y | 2251N0400X | Physical Therapist - Neurology | 62593 | OR |
NPI | 1023397577 |
---|---|
Provider Name | Miss Angelina Marie Ciavarella |
First Address | Portland, OR 97239-4501 |
Second Address | Portland, OR 97239-4501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2011 |
Last Update Date | 14/05/2020 |