Individual
MARTIN EDWARD SUDAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
3814 BOTTICELLI ST, LAKE OSWEGO, OR 97035-1303
(503) 699-8128
Mailing address
3814 BOTTICELLI ST, LAKE OSWEGO, OR 97035-1303
(503) 699-8128
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
7928
OR
Other
Enumeration date
06/29/2007
Last updated
07/08/2007
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