Provider Demographics
NPI:1336474543
Name:PIAZZA, CHRISTA LEE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:LEE
Last Name:PIAZZA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12672 SE STARK ST
Mailing Address - Street 2:PL 125 BLDG A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1058
Mailing Address - Country:US
Mailing Address - Phone:503-254-2652
Mailing Address - Fax:503-254-2814
Practice Address - Street 1:12672 SE STARK ST
Practice Address - Street 2:PL 125 BLDG A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1058
Practice Address - Country:US
Practice Address - Phone:503-254-2652
Practice Address - Fax:503-254-2814
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist