Provider Demographics
NPI:1922052158
Name:AIELLO, DOROTHY DALIA (DPT)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:DALIA
Last Name:AIELLO
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 1:1585 SW MARLOW AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5178
Mailing Address - Country:US
Mailing Address - Phone:503-862-8105
Mailing Address - Fax:503-902-9495
Practice Address - Street 1:1585 SW MARLOW AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5178
Practice Address - Country:US
Practice Address - Phone:503-862-8105
Practice Address - Fax:503-902-9495
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269784Medicaid
ORQ50127Medicare UPIN
OR269784Medicaid