Individual
ALIEZA FORMILLEZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2430 OAK ST SE APT 8, ALBANY, OR 97322-5692
(410) 428-7225
Mailing address
2430 OAK ST SE APT 8, ALBANY, OR 97322-5692
(410) 428-7225
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5720
OR
Other
Enumeration date
07/23/2008
Last updated
07/23/2008
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