Healthcare Provider Details

I. General information

NPI: 1437476173
Provider Name (Legal Business Name): CASEY NAIMAT CARDOSO EP-C, EIM, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CYNTHIA NAIMAT EP-C

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 NE 44TH AVE STE 340
PORTLAND OR
97213-1469
US

IV. Provider business mailing address

1827 NE 44TH AVE STE 340
PORTLAND OR
97213-1469
US

V. Phone/Fax

Practice location:
  • Phone: 503-421-4049
  • Fax:
Mailing address:
  • Phone: 503-421-4049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10357
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number10357
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: