Provider Demographics
NPI:1689967994
Name:HANLIN, MARCEEA GENEA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARCEEA
Middle Name:GENEA
Last Name:HANLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARCEEA
Other - Middle Name:GENEA
Other - Last Name:WOROBEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 4037
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4037
Mailing Address - Country:US
Mailing Address - Phone:503-413-4048
Mailing Address - Fax:503-413-2910
Practice Address - Street 1:19250 SW 65TH AVE
Practice Address - Street 2:MEDICAL PLAZA #1, SUITE 125
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7452
Practice Address - Country:US
Practice Address - Phone:503-692-1670
Practice Address - Fax:503-692-1669
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPT034672251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR03467OtherOREGON STATE LICENSE
ORPENDINGMedicaid