Provider Demographics
NPI:1366635823
Name:GOOD, CARLEE OLSON (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CARLEE
Middle Name:OLSON
Last Name:GOOD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 OSWEGO SMT
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1078
Mailing Address - Country:US
Mailing Address - Phone:503-805-8933
Mailing Address - Fax:503-675-2079
Practice Address - Street 1:17360 HOLY NAMES DR
Practice Address - Street 2:BUILDING D
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-5133
Practice Address - Country:US
Practice Address - Phone:503-675-2004
Practice Address - Fax:503-675-2079
Is Sole Proprietor?:No
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist