Individual
JODIE MARIKO MIYAMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
5330 NE PRESCOTT ST, PORTLAND, OR 97218-2158
(503) 288-6585
Mailing address
25117 SW PARKWAY AVE STE D, WILSONVILLE, OR 97070-9697
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
61099152
WA
225100000X
Physical Therapist
Primary
63894
OR
Other
Enumeration date
11/30/2020
Last updated
11/30/2020
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