Individual
MICHELE SHIVACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT,ATC
Contact information
Practice address
11782 SW BARNES RD, SUITE 300, PORTLAND, OR 97225-5914
(503) 906-4323
(503) 906-4333
Mailing address
11782 SW BARNES RD, SUITE 300, PORTLAND, OR 97225-5914
(503) 906-4323
(503) 906-4333
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
4108
OR
2251X0800X
Orthopedic Physical Therapist
Primary
04108
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04108
LICENSE NUMBER
OR
Enumeration date
01/25/2013
Last updated
09/13/2013
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