Individual
BRYCE GILLESPIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1158 SW 208TH PL, BEAVERTON, OR 97003-1539
(541) 350-2394
Mailing address
1158 SW 208TH PL, BEAVERTON, OR 97003-1539
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
10119652
OR
Other
Enumeration date
08/25/2014
Last updated
08/25/2014
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