Provider Demographics
NPI:1619283900
Name:MACOMBER, SARAH (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MACOMBER
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 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
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 1:29100 SW TOWN CENTER LOOP W
Practice Address - Street 2:SUITE 190
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9315
Practice Address - Country:US
Practice Address - Phone:503-570-7600
Practice Address - Fax:503-570-7602
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60171317225100000X
OR60176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1619283900Medicaid
OR500661045Medicaid
ORP01322200OtherRR
WA1619283900Medicaid
ORR188743Medicare PIN
OR500661045Medicaid
WAG8935835Medicare PIN