Basic Information
| Provider Information | |||||||||
| NPI: | 1033319959 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAEBORI | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 SW ELMHURST AVE | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970051266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036269754 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9135 SW BARNES RD | ||||||||
| Address2: | SUITE 362 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032168112 | ||||||||
| FaxNumber: | 5032164071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2007 | ||||||||
| LastUpdateDate: | 07/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0447 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.