Individual
BETH ALTA SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1114 GEORGIANA ST, PORT ANGELES, WA 98362-4212
(360) 452-6216
(360) 452-8765
Mailing address
16083 SW UPPER BOONES FERRY RD, SUITE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00010627
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326232265
—
WA
01
—
P00724910
RR MEDICARE
WA
Enumeration date
09/04/2007
Last updated
03/11/2013
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