Provider Demographics
NPI:1801870696
Name:LEHMAN, TIMOTHY GILBERT (PT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:GILBERT
Last Name:LEHMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 NE WISTARIA DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2963
Mailing Address - Country:US
Mailing Address - Phone:503-287-7861
Mailing Address - Fax:
Practice Address - Street 1:6336 SE MILWAUKIE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5419
Practice Address - Country:US
Practice Address - Phone:503-230-4833
Practice Address - Fax:503-235-4250
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR117952Medicaid
ROOWCXBSAMedicare ID - Type Unspecified