Provider Demographics
NPI:1336294263
Name:KORTEKAAS, PATRICIA (PT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:KORTEKAAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:KORTEKAAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2780 EMERALD STREET
Mailing Address - Street 2:
Mailing Address - City:EUGEN
Mailing Address - State:OR
Mailing Address - Zip Code:97403
Mailing Address - Country:US
Mailing Address - Phone:541-686-0101
Mailing Address - Fax:541-686-0202
Practice Address - Street 1:4175 EAST AMAZON DRIVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405
Practice Address - Country:US
Practice Address - Phone:541-686-0101
Practice Address - Fax:541-686-0202
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1518225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist