Debra Anderson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

62903 Issued in OR

Practice address

300 Glen Creek Rd NW
Salem, OR 97304

Phone

(503) 990-8627

Fax

(503) 990-8630

NPI assigned

Aug 2, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Debra Domermuth Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1689152597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 NW 18TH AVE",
            "address_2": "STE 400",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972092516",
            "telephone_number": "423-682-8840",
            "fax_number": "423-602-2028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 GLEN CREEK RD NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97304",
            "telephone_number": "503-990-8627",
            "fax_number": "503-990-8630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "DEBRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-02",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "62903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBRA",
            "last_name": "DOMERMUTH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shelly Catrina Andersen
• Allyson Anderson
• Angela N. Anderson, D.O.
• Brian Anderson
• Craig Douglas Anderson, MD
• Deryck Anderson
• Dorothy Jean Anderson, PH.D.
• Gregory Nelson Anderson, MS, CCC-SLP
• Gwenellyn Anderson, ED.D.
• Justin Alton Anderson, DDS

• Physical Therapist in Salem, OR
• Providers in Salem, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.