Individual
JULIE MICHELLE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Contact information
Practice address
12550 SE 93RD AVE, STE 265, CLACKAMAS, OR 97015-9786
(503) 659-9155
(503) 659-7336
Mailing address
11481 SW HALL BLVD, STE 201, PORTLAND, OR 97223-8403
(800) 219-8835
(503) 443-1402
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
40QA00746800
MA
225100000X
Physical Therapist
Primary
4769
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269615
—
OR
Enumeration date
01/24/2006
Last updated
05/15/2009
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