Provider Demographics
NPI:1124393152
Name:REICH, KATHRYN (MSPT)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:REICH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4726 NE ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1968
Mailing Address - Country:US
Mailing Address - Phone:503-288-9100
Mailing Address - Fax:
Practice Address - Street 1:1423 SE 23RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3908
Practice Address - Country:US
Practice Address - Phone:503-236-3108
Practice Address - Fax:503-236-3239
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist