Individual
MRS. MARY E HALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2051 POTTERY AVE., PORT ORCHARD, WA 98366
(360) 876-4461
(360) 876-4482
Mailing address
4560 SE INDUSTRIAL WAY, STE. 100, MILWAUKIE, OR 97222
(971) 206-5200
(971) 206-5203
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
2306604047
VA
225200000X
Physical Therapy Assistant
P160280598
WA
225200000X
Physical Therapy Assistant
Primary
PTA.0013800
CO
Other
Enumeration date
12/04/2012
Last updated
07/06/2016
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