MEDICARE: MARY-JEAN PAULITZ PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2721	OR

General Provider Information

NPI Number	:	1053427245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY-JEAN PAULITZ PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	PO BOX 17557
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-0557
Country	:	US
Telephone Number	:	541-977-2932
Fax Number	:

Provider Business Practice Location Address
First Line	:	5835 NE 122ND AVE
Second Line	:	SUITE 135
City	:	PORTLAND
State	:	OR
Zip	:	97230-1057
Country	:	US
Telephone Number	:	541-977-2932
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	09/13/2007

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Directions to “ MARY-JEAN PAULITZ PHYSICAL THERAPIST” Practice Location

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