Individual
MARK OUELLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1144 WILLAGILLESPIE RD, STE 1, EUGENE, OR 97401-6729
(541) 636-4471
(541) 357-4492
Mailing address
1144 WILLAGILLESPIE RD, STE 1, EUGENE, OR 97401-6729
(541) 636-4471
(541) 357-4992
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5603
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160426
MEDICARE ID#
OR
05
—
5006612413
—
OR
Enumeration date
12/27/2006
Last updated
08/15/2015
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