Individual
TRISHA DANIELLE BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2645 N 17TH ST, COOS BAY, OR 97420
(541) 266-3658
Mailing address
2645 N 17TH ST, COOS BAY, OR 97420
(541) 266-3658
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
06890
OR
Other
Enumeration date
08/20/2010
Last updated
07/24/2014
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