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Individual

SHIRA RACOOSIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1327 SE TACOMA ST UNIT 122, PORTLAND, OR 97202-6639
(971) 361-9442
Mailing address
6919 FAIRFAX RD, BETHESDA, MD 20814-1230

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
27969
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
27969
LICENSE NUMBER
MD
Enumeration date
08/20/2020
Last updated
08/20/2020
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