Individual
SHANNON DEE STODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5300 RIVER RD N, KEIZER, OR 97303-4428
(503) 570-3665
(503) 570-9155
Mailing address
275 LAKEPOINT PL N, APT 334, KEIZER, OR 97303-8317
(503) 798-8176
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8017
OR
Other
Enumeration date
11/29/2007
Last updated
11/29/2007
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