Provider Demographics
NPI:1699859892
Name:DEVOY, ERIN NICOLE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:NICOLE
Last Name:DEVOY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 WINDGATE ST S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5677
Mailing Address - Country:US
Mailing Address - Phone:503-880-9006
Mailing Address - Fax:
Practice Address - Street 1:1655 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4347
Practice Address - Country:US
Practice Address - Phone:503-319-2738
Practice Address - Fax:971-239-5423
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5206OtherOREGON PHYSICAL THERAPY LICENSING BOARD
OR014548022OtherREGENCE BC/BS
WA0211652OtherWA DEPT OF L & I
OR341435OtherPROVIDENCE HEALTH PLANS
OR5001647-37OtherREGENCE BC/HMO
OR240130Medicaid