Provider Demographics
NPI:1407907900
Name:CHAMBERS, DOMINIC (PT)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S STATE ST STE 200G
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3900
Mailing Address - Country:US
Mailing Address - Phone:503-636-3028
Mailing Address - Fax:503-636-1837
Practice Address - Street 1:101 S STATE ST STE 200G
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3900
Practice Address - Country:US
Practice Address - Phone:503-636-3028
Practice Address - Fax:503-636-1837
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist