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NPI Code Detail

MEDICARE: SARAH RACHEL SHINE DPT

MEDICARE: SARAH RACHEL SHINE DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist5435OR

General Provider Information

NPI Number : 1265750624
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH RACHEL SHINE DPT
Provider Business Mailing Address
First Line : 5330 NE PRESCOTT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97218-2158
Country : US
Telephone Number : 503-288-6585
Fax Number : 503-288-0014
Provider Business Practice Location Address
First Line : 5330 NE PRESCOTT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97218-2158
Country : US
Telephone Number : 503-288-6585
Fax Number : 503-288-0014
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2010
Last Update Date : 05/11/2010

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Directions to “ SARAH RACHEL SHINE DPT” Practice Location

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