Provider Demographics
NPI:1619269842
Name:TREEHEART, ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:TREEHEART
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 1:2177 RHODODENDRON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1792
Mailing Address - Country:US
Mailing Address - Phone:760-689-5444
Mailing Address - Fax:619-362-9887
Practice Address - Street 1:2911 TENNYSON AVE STE 204
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-4693
Practice Address - Country:US
Practice Address - Phone:541-515-6194
Practice Address - Fax:541-505-9574
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37197225100000X
225100000X
OR05473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500734828Medicaid