Individual
MRS. LAURA LYNN WALICZEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
9860 SW HALL BLVD, #A3, TIGARD, OR 97223-8896
(503) 902-2123
Mailing address
664 SW RUSTICA TERRACE, PORTLAND, OR 97225
(503) 902-2123
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4954
OR
Other
Enumeration date
11/30/2006
Last updated
12/28/2021
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