Individual
HEATHER JEAN DEFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
9204 SE MITCHELL ST, PORTLAND, OR 97266
(503) 777-6746
(503) 777-0023
Mailing address
9204 SE MITCHELL ST, PORTLAND, OR 97266
(503) 777-6746
(503) 777-0023
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4250
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4250
PHYSICAL THERAPY BOARD
OR
Enumeration date
08/02/2006
Last updated
07/08/2007
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