Basic Information
| Provider Information | |||||||||
| NPI: | 1366635823 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOOD | ||||||||
| FirstName: | CARLEE | ||||||||
| MiddleName: | OLSON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 97 OSWEGO SMT | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970351078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038058933 | ||||||||
| FaxNumber: | 5036752079 | ||||||||
| Practice Location | |||||||||
| Address1: | 17360 HOLY NAMES DR | ||||||||
| Address2: | BUILDING D | ||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970345133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036752004 | ||||||||
| FaxNumber: | 5036752079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2007 | ||||||||
| LastUpdateDate: | 08/19/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4448 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.