Individual
KELLY L VON BARGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA, LMT
Contact information
Practice address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
(971) 206-2314
Mailing address
287 NE 3RD ST APT 209, GRESHAM, OR 97030-7722
(971) 361-6349
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09654
OR
225700000X
Massage Therapist
22780
OR
Other
Enumeration date
01/18/2017
Last updated
11/01/2018
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