Individual
JUNNE LICATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 MIRA MAR AVE, MEDFORD, OR 97504-8546
(541) 857-7131
Mailing address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09803
OR
Other
Enumeration date
09/26/2019
Last updated
09/26/2019
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