Provider Demographics
NPI:1891091385
Name:CALDWELL, EMILY RUST (DPT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RUST
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:M
Other - Last Name:RUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3439 SE HAWTHORNE BLVD # 1025
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5048
Mailing Address - Country:US
Mailing Address - Phone:503-270-3086
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:3439 SE HAWTHORNE BLVD # 1025
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5048
Practice Address - Country:US
Practice Address - Phone:503-270-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP01567041OtherRR MEDICARE
OR500632777Medicaid
ORR173751Medicare PIN
ORP01567041OtherRR MEDICARE
ORR15874Medicare PIN
OR500632777Medicaid