Provider Demographics
NPI:1053427245
Name:PAULITZ, MARY-JEAN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MARY-JEAN
Middle Name:
Last Name:PAULITZ
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17557
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-0557
Mailing Address - Country:US
Mailing Address - Phone:541-977-2932
Mailing Address - Fax:
Practice Address - Street 1:5835 NE 122ND AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1057
Practice Address - Country:US
Practice Address - Phone:541-977-2932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist