Individual
ANDREW CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2191 NW 2ND ST BLDG 4, MCMINNVILLE, OR 97128-9106
(503) 434-9594
(503) 434-6808
Mailing address
2191 NW 2ND ST BLDG 4, MCMINNVILLE, OR 97128-9106
(503) 434-9594
(503) 434-6808
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
61668
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500715224
—
OR
Enumeration date
05/26/2016
Last updated
08/07/2017
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