Provider Demographics
NPI:1194202101
Name:GAYLES, ELAINA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:MARIE
Last Name:GAYLES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 NE VILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-3827
Mailing Address - Country:US
Mailing Address - Phone:503-489-1174
Mailing Address - Fax:503-489-1650
Practice Address - Street 1:2415 NE 134TH ST STE 201
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3032
Practice Address - Country:US
Practice Address - Phone:360-859-3346
Practice Address - Fax:360-859-3357
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist