Provider Demographics
NPI:1720379860
Name:FELIX, MARY ELIZABETH (PT DPT CEEAA)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:FELIX
Suffix:
Gender:F
Credentials:PT DPT CEEAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10075 SW FLICKA PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-8029
Mailing Address - Country:US
Mailing Address - Phone:858-382-3409
Mailing Address - Fax:
Practice Address - Street 1:10075 SW FLICKA PL
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-8029
Practice Address - Country:US
Practice Address - Phone:858-382-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-24
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002677225100000X
CA8188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist