Individual
SHAUNTI BASIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
4805 NE GLISAN STREET, PORTLAND, OR 97213
(503) 215-1111
Mailing address
1702 NE 125TH AVE., PORTLAND, OR 97230
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
62070
OR
Other
Enumeration date
09/01/2018
Last updated
09/01/2018
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