Provider Demographics
NPI:1487847760
Name:TAKAYAMA, VALARIE ANGELINE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:VALARIE
Middle Name:ANGELINE
Last Name:TAKAYAMA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 SW NYBERG ST
Mailing Address - Street 2:STE 200
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8437
Mailing Address - Country:US
Mailing Address - Phone:503-595-8235
Mailing Address - Fax:
Practice Address - Street 1:6530 SW 30TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-1007
Practice Address - Country:US
Practice Address - Phone:503-595-8235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR32682251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics