Individual
DESIRAY ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
5736 NE GLISAN ST, PORTLAND, OR 97213-3750
(503) 863-5880
(503) 863-5881
Mailing address
541 NE 20TH AVE STE 225, PORTLAND, OR 97232-2895
(503) 963-2801
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
65937
OR
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500818078
—
OR
Enumeration date
02/06/2023
Last updated
03/31/2026
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