Provider Demographics
NPI:1417394081
Name:JORAY, ELISE CARLSON
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:CARLSON
Last Name:JORAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT ANGEL
Mailing Address - State:OR
Mailing Address - Zip Code:97362-9540
Mailing Address - Country:US
Mailing Address - Phone:503-845-2736
Mailing Address - Fax:503-845-9229
Practice Address - Street 1:540 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT ANGEL
Practice Address - State:OR
Practice Address - Zip Code:97362-9540
Practice Address - Country:US
Practice Address - Phone:503-845-2736
Practice Address - Fax:503-845-9229
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR03793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist