Individual
MICHELLE FOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4500 KRUSE WAY SUITE 310, LAKE OSWEGO, OR 97035
(503) 620-3407
Mailing address
8546 SW 160TH AVE, BEAVERTON, OR 97007
(503) 330-8751
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6204
OR
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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