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Individual

LORELIE VICENTE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3760 MARKET ST NE, PMB 485, SALEM, OR 97301-1826
(541) 361-0335
Mailing address
3760 MARKET ST NE, PMB 485, SALEM, OR 97301-1826
(541) 361-0335

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6746
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3570484
DRIVER'S LICENSE
OR
Enumeration date
02/21/2014
Last updated
02/21/2014
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