Provider Demographics
NPI:1043400179
Name:TIEU, LY (PT)
Entity Type:Individual
Prefix:
First Name:LY
Middle Name:
Last Name:TIEU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19185 SW 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7558
Mailing Address - Country:US
Mailing Address - Phone:503-885-5360
Mailing Address - Fax:503-885-7362
Practice Address - Street 1:19185 SW 90TH AVE
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7558
Practice Address - Country:US
Practice Address - Phone:503-885-5360
Practice Address - Fax:503-885-7362
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8491383Medicaid
WAP00748167OtherRAILROAD MEDICARE
WAG8868509Medicare PIN
WAG8868508Medicare PIN