Healthcare Provider Details

I. General information

NPI: 1457863714
Provider Name (Legal Business Name): BRIANNA ELIZABETH ABERNATHY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA ELIZABETH VERSTEEG PT, DPT

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2895 SE POWELL VALLEY RD
GRESHAM OR
97080-1492
US

IV. Provider business mailing address

4200 SE HARVEY ST
MILWAUKIE OR
97222-5817
US

V. Phone/Fax

Practice location:
  • Phone: 503-764-6589
  • Fax:
Mailing address:
  • Phone: 405-657-9599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5318
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number127300
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number62496
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: