Provider Demographics
NPI:1558303941
Name:IVERSON, EMILY SOINEY (PT)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:SOINEY
Last Name:IVERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:KATHARINE
Other - Last Name:SOINEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1730 SW SKYLINE BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221
Mailing Address - Country:US
Mailing Address - Phone:503-715-7237
Mailing Address - Fax:503-715-0496
Practice Address - Street 1:1730 SW SKYLINE BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221
Practice Address - Country:US
Practice Address - Phone:503-715-7237
Practice Address - Fax:503-715-0496
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7414225100000X
OR5262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist