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Individual

ELIZABETH TUCKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1011 DESPERADO TRL, SUITE 201, SISTERS, OR 97759-9580
(541) 549-3574
(541) 549-1092
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
61682
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500708594
OR
Enumeration date
05/18/2016
Last updated
07/29/2016
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