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: | |
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: | 503-639-9699 |
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: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OR | 4191 | 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OR | 228805 | Medicaid | |
OR | P00952511 | Other | RR MEDICARE |
OR | P00952511 | Other | RR MEDICARE |
OR | 228805 | Medicaid |