Individual
GAVIN BOEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
755 MISSION ST SE, SALEM, OR 97302-6211
(503) 814-5986
Mailing address
473 MANBRIN DR N, KEIZER, OR 97303-5801
(541) 419-4802
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
64954
OR
Other
Enumeration date
01/27/2025
Last updated
01/27/2025
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