Basic Information
| Provider Information | |||||||||
| NPI: | 1346324191 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILBERTSON | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25195 SW PARKWAY AVE STE 205 | ||||||||
| Address2: | |||||||||
| City: | WILSONVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970709689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035703665 | ||||||||
| FaxNumber: | 5035709155 | ||||||||
| Practice Location | |||||||||
| Address1: | 1950 NE 102ND AVE | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970066514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037260202 | ||||||||
| FaxNumber: | 8664037867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 08/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3825 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | M1036 36 | 01 | OR | PACIFIC SOURCE HEALTH PLA | OTHER | 2003875-02 | 01 | OR | REGENCE BC/HMO | OTHER | 0210756 | 01 | WA | WA DEPT OF LABOR & INDUS | OTHER | 278297 | 05 | OR | MEDICAID | 340869 | 01 | OR | PROVIDENCE HEALTH PLAN | OTHER | 885103002 | 01 | OR | REGENCE BC/BS | OTHER |