Provider Demographics
NPI:1477606002
Name:VAN DEUSEN, CHRISTI A (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:A
Last Name:VAN DEUSEN
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 1:4031 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-5588
Mailing Address - Country:US
Mailing Address - Phone:206-755-9195
Mailing Address - Fax:
Practice Address - Street 1:315 W BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3081
Practice Address - Country:US
Practice Address - Phone:541-206-2271
Practice Address - Fax:541-470-8729
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT0007779225100000X
WA64426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00126564OtherRAILROAD MC#
WAUS2297155OtherAETNA SPECIALIST PIN
WAVA2194OtherBLUE SHIELD #
WA8337354Medicaid
WA0039585OtherLABOR AND INDUSTRIES#
WAVA2194OtherBLUE SHIELD #
WAUS2297155OtherAETNA SPECIALIST PIN