Provider Demographics
NPI:1588413132
Name:GENDREAU, EMELIA ELIZABETH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:EMELIA
Middle Name:ELIZABETH
Last Name:GENDREAU
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 W CASCADE AVE
Mailing Address - Street 2:STE 106 A PMB 7
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031
Mailing Address - Country:US
Mailing Address - Phone:541-399-0988
Mailing Address - Fax:
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:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist