Individual
JACINDA LEE PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5010 NE 33RD AVE, PORTLAND, OR 97211-6946
(503) 481-6627
Mailing address
5010 NE 33RD AVE, PORTLAND, OR 97211-6946
(503) 481-6627
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
7201
OR
Other
Enumeration date
08/27/2009
Last updated
08/27/2009
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