Provider Demographics
NPI:1104165117
Name:WOELFL, ELIZABETH (LMT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:WOELFL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:LITTLEWOLF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:2304 E BURNSIDE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1677
Mailing Address - Country:US
Mailing Address - Phone:503-329-6648
Mailing Address - Fax:
Practice Address - Street 1:2304 E BURNSIDE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1677
Practice Address - Country:US
Practice Address - Phone:503-329-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6099172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist