Individual
MARILYN MILLER VONFOERSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T., M.A.
Contact information
Practice address
577 BONNIE CT NW, SALEM, OR 97304-3208
(503) 365-7554
(503) 364-4872
Mailing address
577 BONNIE CT NW, SALEM, OR 97304-3208
(503) 365-7554
(503) 364-4872
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2190
OR
225100000X
Physical Therapist
5435
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030172000
REGENCE BLUECROSS BLUESHI
OR
05
—
182439
—
OR
01
—
3203119-01
FC65, MEDICARE ADVANTAGE
OR
Enumeration date
02/23/2007
Last updated
07/09/2007
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