Individual
MISS SHELLIE MARIE LYDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
8040 E MILL PLAIN BLVD, VANCOUVER, WA 98664-2002
(360) 882-2778
Mailing address
PO BOX 4825, PORTLAND, OR 97208-4825
(360) 882-2778
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
3424
OR
225X00000X
Occupational Therapist
Primary
OT60794368
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2177601
—
WA
Enumeration date
05/24/2007
Last updated
06/16/2021
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