Individual
SPENCER P BUSHNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
9828 E. BURNSIDE ST, SUITE 250, PORTLAND, OR 97216-2365
(503) 254-3424
Mailing address
5215 SE CESAR E. CHAVEZ, PORTLAND, OR 97202-4215
(503) 254-3424
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6905
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6905
DPT LICENSE
OR
Enumeration date
08/29/2012
Last updated
08/29/2012
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