Healthcare Provider Details

I. General information

NPI: 1487630042
Provider Name (Legal Business Name): MARTHA L FIALA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 SW DENNIS AVE
HILLSBORO OR
97123-3928
US

IV. Provider business mailing address

12525 SW TOOZE RD
SHERWOOD OR
97140-8442
US

V. Phone/Fax

Practice location:
  • Phone: 503-640-3803
  • Fax:
Mailing address:
  • Phone: 503-319-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0280
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: