Provider Demographics
NPI:1942284971
Name:SHALLICE, HANNAH O (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:O
Last Name:SHALLICE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11481 SW HALL BV
Mailing Address - Street 2:STE 201 THERAPEUTIC ASSOCIATES INC
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-443-1402
Practice Address - Street 1:4242 COMMERCE
Practice Address - Street 2:STE A TAI WEST EUGENE PHYSICAL THERAPY
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5418
Practice Address - Country:US
Practice Address - Phone:541-484-9632
Practice Address - Fax:541-484-7466
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR228758Medicaid
OR228758Medicaid