Provider Demographics
NPI:1346324191
Name:GILBERTSON, LISA M (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:GILBERTSON
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 1:25195 SW PARKWAY AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9689
Mailing Address - Country:US
Mailing Address - Phone:503-570-3665
Mailing Address - Fax:503-570-9155
Practice Address - Street 1:1950 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006-6514
Practice Address - Country:US
Practice Address - Phone:503-726-0202
Practice Address - Fax:866-403-7867
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORM1036 36OtherPACIFIC SOURCE HEALTH PLA
OR2003875-02OtherREGENCE BC/HMO
WA0210756OtherWA DEPT OF LABOR & INDUS
OR278297Medicaid
OR340869OtherPROVIDENCE HEALTH PLAN
OR885103002OtherREGENCE BC/BS