Provider Demographics
NPI:1265047724
Name:KETCHUM, ADELIA (DPT)
Entity type:Individual
Prefix:
First Name:ADELIA
Middle Name:
Last Name:KETCHUM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ADDIE
Other - Middle Name:
Other - Last Name:KETCHUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2936 SE MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6635
Mailing Address - Country:US
Mailing Address - Phone:503-407-5927
Mailing Address - Fax:
Practice Address - Street 1:9100 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6772
Practice Address - Country:US
Practice Address - Phone:503-305-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist