Provider Demographics
NPI:1003899592
Name:DUTRA DOPPEE, JAIME LEIGH (PT)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:LEIGH
Last Name:DUTRA DOPPEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JAIME
Other - Middle Name:LEIGH
Other - Last Name:DUTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:18517 SW COLFELT LN
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8873
Mailing Address - Country:US
Mailing Address - Phone:503-925-8780
Mailing Address - Fax:
Practice Address - Street 1:25030 SW PARKWAY AVE
Practice Address - Street 2:101
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9816
Practice Address - Country:US
Practice Address - Phone:503-582-1073
Practice Address - Fax:503-582-1093
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR47742251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
119869Medicare PIN