Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 3657 | OR |
N | 2251P0200X | Physical Therapist - Pediatrics | 3657 | OR |
NPI | 1114125432 |
---|---|
Provider Name | Mrs. Michelle Groesz Swift |
First Address | Portland, OR 97211-4729 |
Second Address | Portland, OR 97229-1101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2007 |
Last Update Date | 08/03/2011 |