Provider Demographics
NPI:1154625697
Name:DIRENFELD-OBRIEN, BETH LORI (PYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:LORI
Last Name:DIRENFELD-OBRIEN
Suffix:
Gender:F
Credentials:PYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 SW CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1009
Mailing Address - Country:US
Mailing Address - Phone:503-957-3710
Mailing Address - Fax:
Practice Address - Street 1:1200 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-6605
Practice Address - Country:US
Practice Address - Phone:503-496-3755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-25
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist