Provider Demographics
NPI:1881724979
Name:EISAMAN, TAMI R (PT)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:R
Last Name:EISAMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11481 SW HALL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:4242 COMMERCE ST
Practice Address - Street 2:SUITE A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5412
Practice Address - Country:US
Practice Address - Phone:541-895-5913
Practice Address - Fax:541-895-5941
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPT 6261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500624548Medicaid
ORR154901Medicare PIN
ORR156653Medicare PIN
ORR154899Medicare PIN