Provider Demographics
NPI:1194981852
Name:DUSTRUDE-LAMPERT, ERIN H (PT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:H
Last Name:DUSTRUDE-LAMPERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:H
Other - Last Name:DUSTRUDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11481 SW HALL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-443-6156
Practice Address - Street 1:20055 SW PACIFIC HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9294
Practice Address - Country:US
Practice Address - Phone:503-625-1691
Practice Address - Fax:503-925-1460
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR155322Medicare PIN