Provider Demographics
NPI:1356682751
Name:CHAU, CAM NGUYET (LMT)
Entity Type:Individual
Prefix:
First Name:CAM
Middle Name:NGUYET
Last Name:CHAU
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13973 SW NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2695
Mailing Address - Country:US
Mailing Address - Phone:503-453-9294
Mailing Address - Fax:888-998-3783
Practice Address - Street 1:13973 SW NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2695
Practice Address - Country:US
Practice Address - Phone:503-453-9294
Practice Address - Fax:888-998-3783
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-09
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12572172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist