Provider Demographics
NPI:1861720039
Name:OSILLA, MARIA THERESA CALIMQUIM (RPT)
Entity type:Individual
Prefix:MISS
First Name:MARIA THERESA
Middle Name:CALIMQUIM
Last Name:OSILLA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 SE 92ND CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2860
Mailing Address - Country:US
Mailing Address - Phone:503-901-3032
Mailing Address - Fax:
Practice Address - Street 1:1609 SE 92ND CT
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2860
Practice Address - Country:US
Practice Address - Phone:503-901-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60122304225100000X
ORPT6129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist