Individual
JUSTIN THOMAS WEATHERFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
9148 SE HIDEAWAY CT, DAMASCUS, OR 97089-6324
(503) 666-4505
Mailing address
9148 SE HIDEAWAY CT, DAMASCUS, OR 97089-6324
(503) 666-4505
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4982
OR
225100000X
Physical Therapist
PT00009852
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
273806
OMAP #
OR
Enumeration date
09/27/2006
Last updated
04/16/2011
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