Basic Information
| Provider Information | |||||||||
| NPI: | 1659562387 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASMAMAW | ||||||||
| FirstName: | MISRAK | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10220 SW GREENBURG RD | ||||||||
| Address2: | LINCOLN CENTER 3, SUITE 201 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972235503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035703665 | ||||||||
| FaxNumber: | 5035709155 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 SE OAK ST. | ||||||||
| Address2: | HILLSBORO REHAB | ||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036488588 | ||||||||
| FaxNumber: | 5036488589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2007 | ||||||||
| LastUpdateDate: | 08/07/2007 | ||||||||
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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 | 225200000X | 8208 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.