Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1134389331 |
---|---|
Provider Name | Mr. Robert Lowell Thomas JR. |
First Address | Portland, OR 97229-8536 |
Second Address | Wilsonville, OR 97070-9697 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 20/12/2011 |