Individual
COREY PHIPPS-DAVISSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
319 NE RUSSET ST, PORTLAND, OR 97211-2815
(503) 289-5571
Mailing address
2003 SW 6TH ST, BATTLE GROUND, WA 98604-3016
(503) 913-8696
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09165
OR
225200000X
Physical Therapy Assistant
P160548479
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09165
PTA LICENSE
OR
01
—
P160548479
PTA LICENSE
WA
Enumeration date
04/30/2015
Last updated
04/30/2015
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