Individual
VICTORIA LOUDERMILK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3320 SE HOLGATE BLVD, PORTLAND, OR 97202-3459
(503) 231-1411
Mailing address
3320 SE HOLGATE BLVD, PORTLAND, OR 97202-3459
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09643
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09643
OREGON PHYSICAL THERAPIST LICENSING BOARD
OR
Enumeration date
08/14/2018
Last updated
08/14/2018
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