MEDICARE: ELISA MAUREEN HAWLEY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4776	OR
2	225100000X	Physical Therapist		WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518941467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA MAUREEN HAWLEY PT

Provider Business Mailing Address
First Line	:	3600 N INTERSTATE AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1106
Country	:	US
Telephone Number	:	503-331-3050
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 N INTERSTATE AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1106
Country	:	US
Telephone Number	:	503-331-3050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	03/07/2022

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