Individual
MARY DICICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25117 SW PARKWAY AVE, WILSONVILLE, OR 97070-9697
(503) 570-3665
Mailing address
1742 SE MARION ST, PORTLAND, OR 97202-7350
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09213
OR
Other
Enumeration date
10/29/2015
Last updated
10/29/2015
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