Provider Demographics
NPI:1821256769
Name:BIRNIE, MARJORIE MCCORMACK (PT)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:MCCORMACK
Last Name:BIRNIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:ANNE
Other - Last Name:BIRNIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1646 SW PARKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2638
Mailing Address - Country:US
Mailing Address - Phone:503-248-0983
Mailing Address - Fax:
Practice Address - Street 1:1646 SW PARKVIEW CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2638
Practice Address - Country:US
Practice Address - Phone:503-248-0983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist