Individual
CONNIE WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC/R
Contact information
Practice address
2219 SE 68TH AVE, PORTLAND, OR 97215-4026
(503) 517-1063
Mailing address
139 SE 81ST AVE, PORTLAND, OR 97215-1530
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-AT-10184976
OR
Other
Enumeration date
02/09/2018
Last updated
02/09/2018
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