Provider Demographics
NPI:1922084326
Name:CORRIGAN, LISA DIANE (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DIANE
Last Name:CORRIGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:503-639-9699
Practice Address - Street 1:2200 NE NEFF RD
Practice Address - Street 2:STE 202, TAI - CENTRAL OREGON BEND
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4281
Practice Address - Country:US
Practice Address - Phone:541-388-7738
Practice Address - Fax:541-312-0121
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR4191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR228805Medicaid
ORP00952511OtherRR MEDICARE
ORP00952511OtherRR MEDICARE
OR228805Medicaid