Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1013489608 |
---|---|
Provider Name | Namita Avarsekar |
First Address | Gresham, OR 97030-7450 |
Second Address | Gresham, OR 97030-7450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2018 |
Last Update Date | 20/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
61421 | LICENSE (01) | OR |