Provider Demographics
NPI:1689933681
Name:CLANCY, SINEAD MARGARET (DPT, PHD)
Entity Type:Individual
Prefix:DR
First Name:SINEAD
Middle Name:MARGARET
Last Name:CLANCY
Suffix:
Gender:F
Credentials:DPT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3859 NW SUNSET VIEW TERR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229
Mailing Address - Country:US
Mailing Address - Phone:619-962-2159
Mailing Address - Fax:
Practice Address - Street 1:3905 SW 117TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-8905
Practice Address - Country:US
Practice Address - Phone:619-962-2159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61980225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669977898OtherCMS