Provider Demographics
NPI:1558430322
Name:MCCULLOCH, MARINA U (PT)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:U
Last Name:MCCULLOCH
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:18019 SW LOWER BOONES FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7228
Mailing Address - Country:US
Mailing Address - Phone:503-753-1537
Mailing Address - Fax:503-573-8004
Practice Address - Street 1:2870 SW CEDAR HILLS BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1354
Practice Address - Country:US
Practice Address - Phone:503-646-9222
Practice Address - Fax:503-350-1226
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist