Provider Demographics
NPI:1164768271
Name:HIMES-FERRIS, ALEXANDRA (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:HIMES-FERRIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:HIMES-FERRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2011 SE CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5407
Mailing Address - Country:US
Mailing Address - Phone:541-515-2620
Mailing Address - Fax:
Practice Address - Street 1:16485 SW PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-3446
Practice Address - Country:US
Practice Address - Phone:503-620-5141
Practice Address - Fax:971-223-0410
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist