Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 60890 | OR |
N | 2251P0200X | Physical Therapist - Pediatrics | PT 22975 | CA |
N | 2251S0007X | Physical Therapist - Sports | 60890 | OR |
N | 2251S0007X | Physical Therapist - Sports | PT22975 | CA |
NPI | 1093998015 |
---|---|
Provider Name | Mrs. Robin Jeanne Bousquet |
First Address | Beaverton, OR 97007-8028 |
Second Address | Beaverton, OR 97007-8028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2007 |
Last Update Date | 05/10/2016 |