Provider Demographics
NPI:1639780646
Name:OHGUSHI, ASUMI ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ASUMI
Middle Name:ANN
Last Name:OHGUSHI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 NE 17TH AVE APT 26
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-4504
Mailing Address - Country:US
Mailing Address - Phone:971-645-0262
Mailing Address - Fax:
Practice Address - Street 1:4424 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2331
Practice Address - Country:US
Practice Address - Phone:503-477-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63820261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy