Healthcare Provider Details

I. General information

NPI: 1962130658
Provider Name (Legal Business Name): EILEEN HYDE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MCNARY ESTATES DR N
KEIZER OR
97303-7459
US

IV. Provider business mailing address

27 ROSEWAY ST UNIT 2
JAMAICA PLAIN MA
02130-2129
US

V. Phone/Fax

Practice location:
  • Phone: 503-463-5231
  • Fax: 503-463-5175
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL26302
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number65764
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: