Individual
SHANDA AILENE MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
13470 SW FARMINGTON RD, BEAVERTON, OR 97005-2618
(503) 644-3311
(503) 627-0112
Mailing address
11481 SW HALL BLVD, STE 201, PORTLAND, OR 97223-8403
(800) 219-8835
(503) 443-1402
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4675
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
299951
—
OR
Enumeration date
11/15/2005
Last updated
11/09/2007
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