Basic Information
| Provider Information | |||||||||
| NPI: | 1154625697 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIRENFELD-OBRIEN | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | LORI | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2821 SW CAROLINA ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972391009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039573710 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 OVERLOOK DR | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970346605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034963755 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/25/2010 | ||||||||
| LastUpdateDate: | 07/26/2019 | ||||||||
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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 | 6381 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.