MEDICARE: MRS. DEBORAH C THRALL MDT CERT PT

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	2533	OR

General Provider Information

NPI Number	:	1194799189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH C THRALL MDT CERT PT

Provider Business Mailing Address
First Line	:	1554 GARDEN ST
Second Line	:	103
City	:	WEST LINN
State	:	OR
Zip	:	97068-3278
Country	:	US
Telephone Number	:	503-723-0347
Fax Number	:	503-655-9305

Provider Business Practice Location Address
First Line	:	1554 GARDEN ST
Second Line	:	103
City	:	WEST LINN
State	:	OR
Zip	:	97068-3278
Country	:	US
Telephone Number	:	503-723-0347
Fax Number	:	503-655-9305

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	05/12/2008

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