Provider Demographics
NPI:1679794747
Name:SYMES, MAUREEN D (PT)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:D
Last Name:SYMES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 MTN VW LN STE 400
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2264
Mailing Address - Country:US
Mailing Address - Phone:503-357-2187
Mailing Address - Fax:503-357-2187
Practice Address - Street 1:1905 MTN VW LN STE 400
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2264
Practice Address - Country:US
Practice Address - Phone:503-357-2187
Practice Address - Fax:503-357-2187
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR107002Medicare PIN