Provider Demographics
NPI:1457644916
Name:KREIZENBECK, SAMANTHA E
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:E
Last Name:KREIZENBECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16784 SW VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-1912
Mailing Address - Country:US
Mailing Address - Phone:503-464-6410
Mailing Address - Fax:
Practice Address - Street 1:2155 NW 173RD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3563
Practice Address - Country:US
Practice Address - Phone:503-352-0735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16765172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist