Individual
ELIZABETH A BLACK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
BS PT
Contact information
Practice address
7927 SE ORIENT DR, GRESHAM, OR 97080
(503) 663-0332
(503) 663-1114
Mailing address
6954 NE DAVIS ST, PORTLAND, OR 97213
(503) 235-0930
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4462
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181821
—
OR
Enumeration date
01/23/2006
Last updated
07/08/2007
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