Provider Demographics
NPI:1356674147
Name:HUGHES, ELIZABETH MARIE (PTA)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:ELIZA
Other - Middle Name:MARIE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:1630 SW MORRISON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1916
Mailing Address - Country:US
Mailing Address - Phone:503-227-7774
Mailing Address - Fax:503-227-7548
Practice Address - Street 1:1630 SW MORRISON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1916
Practice Address - Country:US
Practice Address - Phone:503-227-7774
Practice Address - Fax:503-227-7548
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8601261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy