Provider Demographics
NPI:1477685543
Name:ARMSTRONG, MARLAND KERN (PT)
Entity type:Individual
Prefix:MR
First Name:MARLAND
Middle Name:KERN
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91832 HIGHWAY 104
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-7247
Mailing Address - Country:US
Mailing Address - Phone:503-861-3586
Mailing Address - Fax:
Practice Address - Street 1:2120 EXCHANGE ST STE 104
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3366
Practice Address - Country:US
Practice Address - Phone:503-325-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR229773Medicaid
ORR104372Medicare ID - Type Unspecified