Provider Demographics
NPI:1962880831
Name:GRIFFITH, ANNEKE MARGARET (PT)
Entity type:Individual
Prefix:
First Name:ANNEKE
Middle Name:MARGARET
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANNEKE
Other - Middle Name:MARGARET
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:2925 RIVER RD S STE 200
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3677
Practice Address - Country:US
Practice Address - Phone:503-585-4824
Practice Address - Fax:503-370-2545
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500686151Medicaid
OR500686151Medicaid