NPI 1013258847

Carolyn Fonyo Boggess, LMT

Practitioner Mechanotherapist Corvallis, OR

Practice location

Address: 111 NW 2nd St, Corvallis, OR 97330-4700
Phone: (541) 760-4196
Mailing address: 3590 NW Glenridge Dr, Corvallis, OR 97330-3212

Registered specialties

Mechanotherapist Primary

Other Service Providers Taxonomy 172M00000X Licence 16829 (OR)

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Registry record

NPI: 1013258847
Entity type: Individual
Sex (as registered): Female
NPI issued: 4 Mar 2013
Record last updated: 4 Mar 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.