Individual
JORDAN FUKUMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2621 NE 134TH ST, VANCOUVER, WA 98686
(360) 859-3346
Mailing address
2968 NW MODA WAY APT 628, HILLSBORO, OR 97124-7022
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
Other
Enumeration date
06/21/2017
Last updated
03/17/2018
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