Provider Demographics
NPI:1437561768
Name:SHRADER, CHRISTINE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:SHRADER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:JOWAISZAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1960 NW 167TH PL
Mailing Address - Street 2:STE 200
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4803
Mailing Address - Country:US
Mailing Address - Phone:503-672-6080
Mailing Address - Fax:503-672-6081
Practice Address - Street 1:1960 NW 167TH PL
Practice Address - Street 2:STE 200
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4803
Practice Address - Country:US
Practice Address - Phone:503-672-6080
Practice Address - Fax:503-672-6081
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500671681Medicaid
OR0327670OtherWA L&I
OR500671681Medicaid