Provider Demographics
NPI:1831878917
Name:FUGATE, ALYSON MARIE (DPT)
Entity type:Individual
Prefix:DR
First Name:ALYSON
Middle Name:MARIE
Last Name:FUGATE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:MARIE
Other - Last Name:GALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:765 SW 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-0830
Mailing Address - Country:US
Mailing Address - Phone:417-207-8210
Mailing Address - Fax:
Practice Address - Street 1:18040 SW LOWER BOONES FERRY RD STE 200
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7259
Practice Address - Country:US
Practice Address - Phone:503-216-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64622225100000X
WACP017394T225100000X
MO2022038732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist