Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 7946 | OR |
NPI | 1013192517 |
---|---|
Provider Name | Ms. Kathleen Elizabeth King |
First Address | Portland, OR 97205-2411 |
Second Address | Portland, OR 97205-2411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2008 |
Last Update Date | 24/09/2008 |