Healthcare Provider Details

I. General information

NPI: 1205068947
Provider Name (Legal Business Name): ALISSA A CAMERON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 SE STARK ST GRESHAM
GRESHAM OR
97030-3331
US

IV. Provider business mailing address

1480 NE VILLAGE ST FAIRVIEW
FAIRVIEW OR
97024-3827
US

V. Phone/Fax

Practice location:
  • Phone: 503-328-0222
  • Fax: 503-328-0223
Mailing address:
  • Phone: 503-489-6250
  • Fax: 503-489-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6006
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: