Provider Demographics
NPI:1457440331
Name:MUCHA, TAMARA JANE (MPT)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:JANE
Last Name:MUCHA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 N INTERSTATE AVE
Mailing Address - Street 2:KAISER PERMANENTE PAIN MANAGEMENT CLINIC
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3325 N INTERSTATE AVE
Practice Address - Street 2:KAISER PERMANENTE PAIN MANAGEMENT CLINIC
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1020
Practice Address - Country:US
Practice Address - Phone:503-813-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4070225100000X
WAPT00008265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist