Individual
MS. SARA KIRSTIN EKELUND SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T., D.P.T.
Contact information
Practice address
815 NW 9TH ST, SUITE180, CORVALLIS, OR 97330-6173
(541) 768-5157
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5219
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0329390
WA L&I
OR
05
—
500654086
—
OR
Enumeration date
11/12/2006
Last updated
11/11/2020
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