Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 3538 | OR |
NPI | 1063628436 |
---|---|
Provider Name | Mr. Craig Anderson |
First Address | Portland, OR 97213-3063 |
Second Address | Portland, OR 97213-3063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |