Provider Demographics
NPI:1508817818
Name:CAUSTON, NANCY (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CAUSTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 NE BELKNAP CT
Mailing Address - Street 2:STE 107
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5113
Mailing Address - Country:US
Mailing Address - Phone:503-615-5969
Mailing Address - Fax:503-615-5971
Practice Address - Street 1:4950 NE BELKNAP CT
Practice Address - Street 2:STE 107
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5113
Practice Address - Country:US
Practice Address - Phone:503-615-5969
Practice Address - Fax:503-615-5971
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR2353OtherSTATE PT LICENSE
ORR134833Medicare PIN