Individual
MIKE STUART DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5415 SW WESTGATE DR STE L3, PORTLAND, OR 97221-2409
(503) 297-3003
(503) 297-9414
Mailing address
1102 RYAN CT, WEST LINN, OR 97068-4034
(503) 655-5698
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
1353
MT
225200000X
Physical Therapy Assistant
Primary
8463
OR
Other
Enumeration date
07/03/2007
Last updated
07/08/2007
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