Provider Demographics
NPI:1164756060
Name:PALISCA, LINDSY R (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LINDSY
Middle Name:R
Last Name:PALISCA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LINDSY
Other - Middle Name:R
Other - Last Name:TRIBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:10215 SW PARKWAY
Practice Address - Street 2:SUITE D
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5036
Practice Address - Country:US
Practice Address - Phone:503-292-3583
Practice Address - Fax:503-292-1022
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8682225100000X
OR6412225100000X
WAPT60291169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1164756060Medicaid
OR500631337Medicaid
WAP01343769OtherRR MEDICARE
ORR171220Medicare PIN
ORR158555Medicare PIN
WA1164756060Medicaid
OR500631337Medicaid
WAP01343769OtherRR MEDICARE
WAG8924605Medicare PIN