Individual
LISA BRADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-6059
Mailing address
10100 SE BRISTOL LOOP, HAPPY VALLEY, OR 97086-3238
(503) 545-5510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5620
OR
Other
Enumeration date
09/02/2009
Last updated
09/02/2009
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