Active NPI
Elissa Andresen
- Physical Therapy Assistant
- Portland, OR
National Provider Identifier
1306269113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 08823
- Practice address
- 3320 SE Holgate Blvd
Portland, OR 97202-3459 - Phone
- (503) 231-1411
- NPI assigned
- Jan 29, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 08823 | OR | Primary |
Addresses
Primary practice location
3320 SE Holgate Blvd
Portland, OR 97202-3459
Mailing address
8700 NE Thompson St
Portland, OR 97220-5471
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08823 | OR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390953600000",
"number": "1306269113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8700 NE THOMPSON ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972205471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3320 SE HOLGATE BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972023459",
"telephone_number": "503-231-1411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDRESEN",
"first_name": "ELISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-01-29",
"last_updated": "2014-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OR",
"license": "08823",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.