Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2108 | OR |
N | 2251G0304X | Physical Therapist - Geriatrics | 6194 | WA |
NPI | 1265628523 |
---|---|
Provider Name | Ms. Joan Marie Brassfield |
First Address | Wilsonville, OR 97070-9697 |
Second Address | Portland, OR 97223-5503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2007 |
Last Update Date | 20/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
204982 | (05) | OR |