Healthcare Provider Details

I. General information

NPI: 1295051837
Provider Name (Legal Business Name): KELLY MARIE CHOUNARD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY MARIE FINNEY

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 HARLOW RD STE 120
SPRINGFIELD OR
97477-1341
US

IV. Provider business mailing address

16083 SW UPPER BOONES FERRY RD STE 300
TIGARD OR
97224-7736
US

V. Phone/Fax

Practice location:
  • Phone: 541-736-8870
  • Fax: 541-736-8860
Mailing address:
  • Phone: 503-443-6156
  • Fax: 503-639-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501015069
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6253
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: