Provider Demographics
NPI:1114350899
Name:DELAPAZ, ALEX LUIS (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:LUIS
Last Name:DELAPAZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 SE GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3435
Mailing Address - Country:US
Mailing Address - Phone:503-577-0318
Mailing Address - Fax:503-710-9221
Practice Address - Street 1:1235 SE GRAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3435
Practice Address - Country:US
Practice Address - Phone:503-577-0318
Practice Address - Fax:503-710-9221
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500661454Medicaid
ORP01241225OtherRR MEDICARE
OR1164899373OtherTYPE 2 NPI
OR1164899373OtherTYPE 2 NPI