Healthcare Provider Details

I. General information

NPI: 1225311210
Provider Name (Legal Business Name): SHELLEY PIERS-VANDERPLOEG DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24076 SE STARK ST SUITE 200
GRESHAM OR
97030-3373
US

IV. Provider business mailing address

24076 SE STARK ST SUITE 200
GRESHAM OR
97030-3373
US

V. Phone/Fax

Practice location:
  • Phone: 503-491-1667
  • Fax:
Mailing address:
  • Phone: 503-491-1667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6584
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: