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Individual

LAURA JO HARDEBECK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
11782 SW BARNES RD STE 300, PORTLAND, OR 97225-5933
(503) 214-5200
(503) 906-1519
Mailing address
16083 SW UPPER BOONES FERRY RD, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
19501
CA
225100000X
Physical Therapist
Primary
2356
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0257960
WASHINGTON L& I
01
0328996
WA L&I
OR
05
052154
OR
01
P00022831
RR MEDICARE PTAN
OR
Enumeration date
03/01/2006
Last updated
01/12/2021
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