Provider Demographics
NPI:1669635215
Name:EVANS, LAURA ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELIZABETH
Other - Last Name:HIGHAM
Other - Suffix:
Other - Last Name Type:Former Name
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 1:5880 NE CORNELL RD
Practice Address - Street 2:STE C
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9075
Practice Address - Country:US
Practice Address - Phone:503-844-9294
Practice Address - Fax:503-615-0212
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP01820086OtherRR MEDICARE
OR242413Medicaid
ORP01820086OtherRR MEDICARE