Provider Demographics
NPI:1033139019
Name:SPENCER, KRISTINE J (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:J
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8890 SW HOLLY LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-8746
Mailing Address - Country:US
Mailing Address - Phone:503-682-7565
Mailing Address - Fax:503-682-8750
Practice Address - Street 1:8890 SW HOLLY LN
Practice Address - Street 2:SUITE B
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8746
Practice Address - Country:US
Practice Address - Phone:503-682-7565
Practice Address - Fax:503-682-8750
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR105927Medicare PIN