Individual
MRS. MOLLY ANN FAUSKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
17550 PROVOST ST STE 201A, LAKE OSWEGO, OR 97034-5199
(503) 872-2441
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4033
OR
Other
Enumeration date
08/03/2018
Last updated
04/21/2023
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