Individual
MS. EMILY G ANTONISHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.T.
Contact information
Practice address
2350 NW CENTURY DR STE 100, CORVALLIS, OR 97330-3495
(541) 754-1265
Mailing address
444 NW ELKS DR, CORVALLIS, OR 97330-3745
(541) 754-1150
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
06907
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500650076
—
OR
Enumeration date
09/13/2012
Last updated
11/05/2014
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