Provider Demographics
NPI:1275533978
Name:DUFFY, ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:DUFFY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 SW DOLPH ST
Mailing Address - Street 2:ATTN: ELIZABETH DUFFY
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4337
Mailing Address - Country:US
Mailing Address - Phone:503-244-1967
Mailing Address - Fax:
Practice Address - Street 1:7521 SW GARDEN HOME RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-7428
Practice Address - Country:US
Practice Address - Phone:503-757-2123
Practice Address - Fax:503-977-7983
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AC00755171100000X
OR2305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR108115Medicare ID - Type Unspecified