Basic Information
| Provider Information | |||||||||
| NPI: | 1205068947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMERON | ||||||||
| FirstName: | ALISSA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1480 NE VILLAGE ST | ||||||||
| Address2: | FAIRVIEW | ||||||||
| City: | FAIRVIEW | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970243827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034896250 | ||||||||
| FaxNumber: | 5034891650 | ||||||||
| Practice Location | |||||||||
| Address1: | 25500 SE STARK ST | ||||||||
| Address2: | GRESHAM | ||||||||
| City: | GRESHAM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970303331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033280222 | ||||||||
| FaxNumber: | 5033280223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2009 | ||||||||
| LastUpdateDate: | 11/08/2018 | ||||||||
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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 | 6006 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.