Provider Demographics
NPI:1669883583
Name:NELSON, KERI MARIE (DPT)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:MARIE
Last Name:NELSON
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 1:12948 SE WINSTON RD
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97089-7606
Mailing Address - Country:US
Mailing Address - Phone:503-895-1320
Mailing Address - Fax:503-296-2319
Practice Address - Street 1:7203 SE RAYMOND ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-4323
Practice Address - Country:US
Practice Address - Phone:503-895-1320
Practice Address - Fax:503-296-2319
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist