Provider Demographics
NPI:1467640342
Name:MATHIAS, DANA (PT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:PELLETIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:318 NE 99TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-5902
Practice Address - Country:US
Practice Address - Phone:350-571-2195
Practice Address - Fax:360-571-2408
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7843225100000X
WAPT60147275225100000X
OR6815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01582593OtherRR MEDICARE
OR500645425Medicaid
ORP01153282OtherRR MEDICARE
WA1467640342Medicaid
WA325056OtherWA L&I
WA325056OtherWA L&I
OR500645425Medicaid
ORR169328Medicare PIN
ORR168393Medicare PIN
WAP01582593OtherRR MEDICARE
WAG8911112Medicare PIN
ORP01153282OtherRR MEDICARE