Provider Demographics
NPI:1407015332
Name:OLDHAM, ELIZABETH SUE (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUE
Last Name:OLDHAM
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 1:128 BEACON HILL DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-5859
Mailing Address - Country:US
Mailing Address - Phone:360-423-4060
Mailing Address - Fax:360-578-5983
Practice Address - Street 1:128 BEACON HILL DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-5859
Practice Address - Country:US
Practice Address - Phone:360-423-4060
Practice Address - Fax:360-578-5983
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist