Healthcare Provider Details

I. General information

NPI: 1538659578
Provider Name (Legal Business Name): CLAIRE VALENTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24076 SE STARK ST
GRESHAM OR
97030
US

IV. Provider business mailing address

24076 SE STARK ST STE 200
GRESHAM OR
97030-3376
US

V. Phone/Fax

Practice location:
  • Phone: 503-957-1642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number633320
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: