Individual
CAROLYN FONYO BOGGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
111 NW 2ND ST, CORVALLIS, OR 97330-4700
(541) 760-4196
Mailing address
3590 NW GLENRIDGE DR, CORVALLIS, OR 97330-3212
(541) 760-4196
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
16829
OR
Other
Enumeration date
03/04/2013
Last updated
03/04/2013
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