Healthcare Provider Details

I. General information

NPI: 1467668418
Provider Name (Legal Business Name): ANNE DAVIS HUFFINGTON-CARROLL M.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 NE GLISAN ST
PORTLAND OR
97213-3063
US

IV. Provider business mailing address

7062 NE EVERETT ST
PORTLAND OR
97213-5632
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-4033
  • Fax: 503-238-4553
Mailing address:
  • Phone: 503-252-3975
  • Fax: 503-238-4553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4021
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: