Provider Demographics
NPI:1851373997
Name:HALEWYN, ENID ELIZE (PT)
Entity Type:Individual
Prefix:
First Name:ENID
Middle Name:ELIZE
Last Name:HALEWYN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-443-1402
Practice Address - Street 1:1114 GEORGIANA ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-4212
Practice Address - Country:US
Practice Address - Phone:360-452-6216
Practice Address - Fax:360-452-8765
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1365225100000X
WAPT00003874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1851373997Medicaid
OR295429Medicaid
WA8860603Medicare PIN
WA1851373997Medicaid
OR295429Medicaid