Individual
KYLA JOHANNA WALISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
17355 BOONES FERRY RD, STE. B, LAKE OSWEGO, OR 97035-5202
(503) 632-0844
(503) 635-0812
Mailing address
16083 SW UPPER BOONES FERRY RD, SUITE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6913
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500648450
—
OR
01
—
P01554277
RR MEDICARE
OR
Enumeration date
08/14/2012
Last updated
01/05/2016
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