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Individual

LINDA KAY HARMON-PROVOST

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
19250 SW 65TH AVE, MEDICAL PLAZA #1 SUITE 125, TUALATIN, OR 97062-7452
(503) 692-1670
(503) 692-1669
Mailing address
PO BOX 4037, PORTLAND, OR 97208-4037
(503) 413-4048
(503) 413-2910

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT3258
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3258
OREGON PT LICENSE
OR
05
PENDING
OR
Enumeration date
11/19/2009
Last updated
11/19/2009
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