Individual
JOHN MATTHEW TAN MODINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
332 NE SAN RAFAEL ST, PORTLAND, OR 97212-3948
(503) 288-2615
Mailing address
10804 NE 44TH ST, VANCOUVER, WA 98682-6610
(360) 949-8491
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
64474
OR
Other
Enumeration date
05/27/2022
Last updated
05/27/2022
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