Provider Demographics
NPI:1447423454
Name:SESTRIC, KRISTEN (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:SESTRIC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:#300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:61615 ATHLETIC CLUB DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3247
Practice Address - Country:US
Practice Address - Phone:541-382-7890
Practice Address - Fax:541-382-7498
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2108225100000X
OR60699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0328956OtherWA L&I
OR0328959OtherWA L&I
OR0328960OtherWA L&I
OR0328962OtherWA L&I
OR500675016Medicaid
ORR177338Medicare PIN