Provider Demographics
NPI:1003171125
Name:POPE, MARIANE DRYGAS (PT)
Entity Type:Individual
Prefix:MS
First Name:MARIANE
Middle Name:DRYGAS
Last Name:POPE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MARIANE
Other - Middle Name:TERESA
Other - Last Name:DRYGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2191 NW 2ND ST
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-9108
Mailing Address - Country:US
Mailing Address - Phone:503-434-9594
Mailing Address - Fax:503-434-6808
Practice Address - Street 1:2191 NW 2ND ST
Practice Address - Street 2:BUILDING 4
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-9108
Practice Address - Country:US
Practice Address - Phone:503-434-9594
Practice Address - Fax:503-434-6808
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist