Provider Demographics
NPI:1225430002
Name:NATHAN, TAMARINE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:TAMARINE
Middle Name:
Last Name:NATHAN
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 1:12540 SW 68TH AVE.
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8597
Mailing Address - Country:US
Mailing Address - Phone:503-974-9078
Mailing Address - Fax:503-974-9083
Practice Address - Street 1:12540 SW 68TH AVE.
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8597
Practice Address - Country:US
Practice Address - Phone:503-974-9078
Practice Address - Fax:503-974-9083
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 416372251X0800X
OR616232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic