Provider Demographics
NPI:1386624211
Name:YORK, RENAY (PT)
Entity type:Individual
Prefix:MS
First Name:RENAY
Middle Name:
Last Name:YORK
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:PO BOX 22075
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2075
Mailing Address - Country:US
Mailing Address - Phone:503-353-1278
Mailing Address - Fax:503-353-1273
Practice Address - Street 1:12119 SE STEVENS CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-8620
Practice Address - Country:US
Practice Address - Phone:503-353-1278
Practice Address - Fax:503-353-1273
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR270001Medicaid
OR270001Medicaid
OR132666Medicare PIN