Provider Demographics
NPI:1700193885
Name:CLOUGHERTY, ERIN C (DPT)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:C
Last Name:CLOUGHERTY
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 1:6455 SW NYBERG LN
Mailing Address - Street 2:APT A211
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9704
Mailing Address - Country:US
Mailing Address - Phone:503-692-2406
Mailing Address - Fax:
Practice Address - Street 1:19260 SW 65TH AVE
Practice Address - Street 2:SUITE 285
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-5701
Practice Address - Country:US
Practice Address - Phone:503-692-2406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist