Provider Demographics
NPI:1912928078
Name:OSBORNE, MARIAH D (DPT)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:D
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:D
Other - Last Name:HEIKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:503-443-6156
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:541-484-9632
Practice Address - Fax:541-484-7466
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR170856Medicare PIN