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NPI Code Detail

MEDICARE: ELISSA ANDRESEN

MEDICARE: ELISSA ANDRESEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant08823OR

General Provider Information

NPI Number : 1306269113
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISSA ANDRESEN
Provider Business Mailing Address
First Line : 8700 NE THOMPSON ST
Second Line :
City : PORTLAND
State : OR
Zip : 97220-5471
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3320 SE HOLGATE BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97202-3459
Country : US
Telephone Number : 503-231-1411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2014
Last Update Date : 01/29/2014

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Directions to “ ELISSA ANDRESEN ” Practice Location

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