Healthcare Provider Details

I. General information

NPI: 1518664895
Provider Name (Legal Business Name): ELIZABETH BIESEMEYER DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24076 SE STARK ST STE 210
GRESHAM OR
97030-3376
US

IV. Provider business mailing address

10121 SE SUNNYSIDE RD STE 208
CLACKAMAS OR
97015-5750
US

V. Phone/Fax

Practice location:
  • Phone: 503-491-1666
  • Fax: 503-491-1667
Mailing address:
  • Phone: 503-491-1666
  • Fax: 503-491-1667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP055474T
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-23750
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: