Individual
KELSEY WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
441 WERTH BLVD., NEWBERG, OR 97123
(503) 538-9436
Mailing address
441 WERTH BLVD., NEWBERG, OR 97123
(503) 538-9436
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
60690
OR
Other
Enumeration date
07/16/2014
Last updated
08/20/2014
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