Healthcare Provider Details

I. General information

NPI: 1467534412
Provider Name (Legal Business Name): STEPHANIE W CISNEROS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 SE CIRCUIT DR STE 140
HILLSBORO OR
97129-1961
US

IV. Provider business mailing address

7305 SE CIRCUIT DR STE 140
HILLSBORO OR
97129-1961
US

V. Phone/Fax

Practice location:
  • Phone: 971-501-4905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License NumberPT60839924
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7438
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number7438
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number62657
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: