Provider Demographics
NPI:1770917163
Name:DOROTHY EPSTEIN PHYSICAL THERAPY
Entity type:Organization
Organization Name:DOROTHY EPSTEIN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:503-412-8691
Mailing Address - Street 1:2538 NE BROADWAY ST
Mailing Address - Street 2:F-1
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1872
Mailing Address - Country:US
Mailing Address - Phone:971-279-4268
Mailing Address - Fax:871-223-7122
Practice Address - Street 1:2538 NE BROADWAY ST
Practice Address - Street 2:F-1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1872
Practice Address - Country:US
Practice Address - Phone:971-279-4268
Practice Address - Fax:971-223-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR173686Medicare PIN