Provider Demographics
NPI:1467687517
Name:MILITANTE, KRISTINE MARQUEZ (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARQUEZ
Last Name:MILITANTE
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 1:2756 NW EDENBOWER BLVD
Mailing Address - Street 2:APT 7
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6228
Mailing Address - Country:US
Mailing Address - Phone:360-980-2899
Mailing Address - Fax:
Practice Address - Street 1:1609 SE 92ND CT
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2860
Practice Address - Country:US
Practice Address - Phone:360-737-7527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist