Provider Demographics
NPI:1700147899
Name:PUK, VALERIA
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:
Last Name:PUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VALERIA
Other - Middle Name:
Other - Last Name:PUK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:15962 BOONES FERRY RD # SUT209
Mailing Address - Street 2:15962 SW BOONES FERRY RD. SUT 209
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4351
Mailing Address - Country:US
Mailing Address - Phone:503-636-2440
Mailing Address - Fax:
Practice Address - Street 1:15962 BOONES FERRY RD # SUT209
Practice Address - Street 2:15962 SW BOONESFERRY RD.# SUT 209
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4351
Practice Address - Country:US
Practice Address - Phone:503-636-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR#7876225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist