Healthcare Provider Details

I. General information

NPI: 1275533978
Provider Name (Legal Business Name): ELIZABETH DUFFY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7521 SW GARDEN HOME RD
PORTLAND OR
97223-7428
US

IV. Provider business mailing address

1314 SW DOLPH ST ATTN: ELIZABETH DUFFY
PORTLAND OR
97219-4337
US

V. Phone/Fax

Practice location:
  • Phone: 503-757-2123
  • Fax: 503-977-7983
Mailing address:
  • Phone: 503-244-1967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00755
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: