Provider Demographics
NPI:1306126321
Name:BOTEZ, LUCIA A
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:A
Last Name:BOTEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9584 SE PARKWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-6385
Mailing Address - Country:US
Mailing Address - Phone:503-995-8748
Mailing Address - Fax:
Practice Address - Street 1:7320 SW HUNZIKER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8283
Practice Address - Country:US
Practice Address - Phone:503-443-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist