Provider Demographics
NPI:1497127674
Name:PHILBROOK, LI-ZANDRE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LI-ZANDRE
Middle Name:
Last Name:PHILBROOK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LI-ZANDRE
Other - Middle Name:
Other - Last Name:VAN EEDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:14823 SW BROOKE CT
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140
Mailing Address - Country:US
Mailing Address - Phone:503-415-0349
Mailing Address - Fax:503-554-3918
Practice Address - Street 1:14823 SW BROOKE CT
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140
Practice Address - Country:US
Practice Address - Phone:503-415-0349
Practice Address - Fax:503-554-3918
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR606142251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic