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General NPI Number Information
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NPI Number | 1265783518
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Entity Type | Individual
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Provider Name | TIFFANY CARLSON
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Gender | Female
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 1750 BLANKENSHIP RD SUITE 295
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City | WEST LINN
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State | OR
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Zip | 97068-5101
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Country | US
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Telephone | 503-344-4378
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1862
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City | OREGON CITY
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State | OR
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Zip | 97045-0042
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Country | US
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Telephone | 503-313-3373
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 226300000X
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Taxonomy Name | Kinesiotherapist
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License Number | T59079
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License Number State | OR
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