Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 4174 | OR |
NPI | 1235329657 |
---|---|
Provider Name | Ms. Suzanne Marie Belatti |
First Address | Portland, OR 97230-1733 |
Second Address | Wilsonville, OR 97070-9697 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 01/08/2007 |