Individual
MARY GRACE A BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
11782 SW BARNES RD STE 300, PORTLAND, OR 97225-5933
(503) 906-4323
(503) 906-4319
Mailing address
1426 S FAIRFIELD AVE, LOMBARD, IL 60148-4669
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT63986
OR
Other
Enumeration date
05/21/2012
Last updated
12/29/2023
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