Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 64109 | OR |
NPI | 1194390815 |
---|---|
Provider Name | Quinn Garner |
First Address | Corvallis, OR 97339-1189 |
Second Address | Corvallis, OR 97331-8629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2021 |
Last Update Date | 14/06/2021 |