Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 64058 | OR |
Y | 225100000X | Physical Therapist | 64058 | OR |
NPI | 1053984542 |
---|---|
Provider Name | Zachery Paul Christenson |
First Address | Mcminnville, OR 97128-2656 |
Second Address | Mcminnville, OR 97128-2656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2021 |
Last Update Date | 21/07/2021 |