Provider Demographics
NPI:1205068947
Name:CAMERON, ALISSA A (PT)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:A
Last Name:CAMERON
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 1:1480 NE VILLAGE ST
Mailing Address - Street 2:FAIRVIEW
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-3827
Mailing Address - Country:US
Mailing Address - Phone:503-489-6250
Mailing Address - Fax:503-489-1650
Practice Address - Street 1:25500 SE STARK ST
Practice Address - Street 2:GRESHAM
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3331
Practice Address - Country:US
Practice Address - Phone:503-328-0222
Practice Address - Fax:503-328-0223
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist