Provider Demographics
NPI:1235331489
Name:HIXON, CLEA CAMILLA (MSPT)
Entity Type:Individual
Prefix:
First Name:CLEA
Middle Name:CAMILLA
Last Name:HIXON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:118 17TH AVE E
Practice Address - Street 2:#2
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5214
Practice Address - Country:US
Practice Address - Phone:206-322-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1235331489Medicaid
WA1265331489Medicaid
WA1265331489Medicaid