Provider Demographics
NPI:1760935514
Name:PEARSON, PHOEBE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 SE 3RD AVE
Mailing Address - Street 2:# 74
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-4555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1034 SE 96TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-1150
Practice Address - Country:US
Practice Address - Phone:503-546-7640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist