Provider Demographics
NPI:1396269452
Name:LAMBERT, STEPHANIE DIANE (PT, DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DIANE
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DIANE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4859 MEADOWS RD STE 161
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2628
Mailing Address - Country:US
Mailing Address - Phone:503-387-6081
Mailing Address - Fax:503-908-1518
Practice Address - Street 1:4859 MEADOWS RD STE 161
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2628
Practice Address - Country:US
Practice Address - Phone:503-387-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist