Provider Demographics
NPI:1255474581
Name:ZOSEL, KRISTIN JANE (MS PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JANE
Last Name:ZOSEL
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 52194
Mailing Address - Street 2:DEPT CODE 960
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-2194
Mailing Address - Country:US
Mailing Address - Phone:503-489-1781
Mailing Address - Fax:503-489-1650
Practice Address - Street 1:308 N IVY ST
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3704
Practice Address - Country:US
Practice Address - Phone:503-263-6786
Practice Address - Fax:503-263-6451
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR4979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278083Medicaid
ORR136917Medicare PIN
ORR114778Medicare PIN
OR278083Medicaid
ORR143321Medicare PIN
ORR114556Medicare PIN
ORR143310Medicare PIN
ORR114519Medicare PIN