Provider Demographics
NPI:1548591183
Name:COSTA, ELIZABETH CHAPMAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CHAPMAN
Last Name:COSTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4334 NE CESAR E CHAVEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-8230
Mailing Address - Country:US
Mailing Address - Phone:646-942-1224
Mailing Address - Fax:
Practice Address - Street 1:ESD 112
Practice Address - Street 2:2500 NE 65TH AVENUE
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-5506
Practice Address - Country:US
Practice Address - Phone:360-750-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6131225100000X
WA601673412251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics