Provider Demographics
NPI:1144290263
Name:STORFJORD, MARIANN (PT)
Entity type:Individual
Prefix:
First Name:MARIANN
Middle Name:
Last Name:STORFJORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11481 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 1:691 MURPHY RD
Practice Address - Street 2:SUITE 126 TAI MEDFORD PHYSICAL THERAPY
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4350
Practice Address - Country:US
Practice Address - Phone:541-779-1041
Practice Address - Fax:541-779-8704
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR1969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist