Individual
MRS. MIRIAN W GROENENDAAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1957 THOMPSON RD., COOS BAY, OR 97420-2031
(541) 266-7050
(541) 266-0180
Mailing address
1957 THOMPSON RD, COOS BAY, OR 97420-2031
(541) 266-7050
(541) 266-0180
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1813
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182751
—
OR
01
—
410254301
REGENCE BCBS
OR
Enumeration date
01/30/2007
Last updated
05/18/2012
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