Provider Demographics
NPI:1437476173
Name:CARDOSO, CASEY NAIMAT (EP-C, EIM, LMT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:NAIMAT
Last Name:CARDOSO
Suffix:
Gender:F
Credentials:EP-C, EIM, LMT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:NAIMAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EP-C
Mailing Address - Street 1:1827 NE 44TH AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1469
Mailing Address - Country:US
Mailing Address - Phone:503-421-4049
Mailing Address - Fax:
Practice Address - Street 1:1827 NE 44TH AVE STE 340
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1469
Practice Address - Country:US
Practice Address - Phone:503-421-4049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
OR10357225700000X, 226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10357OtherOREGON BOARD OF MASSAGE THERAPISTS
1049219OtherAMERCIAN COLLEGE OF SPORT MEDICINE