Provider Demographics
NPI:1558616656
Name:SCARBOROUGH, EVELYN LEE
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:LEE
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:14711 FRYELANDS BLVD SE STE 153
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2950
Practice Address - Country:US
Practice Address - Phone:360-794-4892
Practice Address - Fax:360-794-4679
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08033225100000X
WA60757665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2090853Medicaid
LA1174173Medicaid
WA2090853Medicaid