Basic Information
| Provider Information | |||||||||
| NPI: | 1649657990 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALTHAUS | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | KAYLYN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6960 N VINCENT AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972175133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033803368 | ||||||||
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| Practice Location | |||||||||
| Address1: | 914 NW 13TH AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972093039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712249000 | ||||||||
| FaxNumber: | 9712449005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2015 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.