Provider Demographics
NPI:1548625023
Name:MURRAY, ALISHA (PTA)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13715 SE EASTRIDGE DR
Mailing Address - Street 2:APT 12
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4717
Mailing Address - Country:US
Mailing Address - Phone:509-703-2793
Mailing Address - Fax:
Practice Address - Street 1:12545 SW CABALLERO CT
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7705
Practice Address - Country:US
Practice Address - Phone:503-319-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160097440225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant