Provider Demographics
NPI:1477744605
Name:PANAGOS, CHRISTINE MARY (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARY
Last Name:PANAGOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:MARY
Other - Last Name:PANAGOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:6217 NE 33RD AVE
Mailing Address - Street 2:SUITE 156
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-7311
Mailing Address - Country:US
Mailing Address - Phone:503-784-5843
Mailing Address - Fax:
Practice Address - Street 1:6217 NE 33RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-7311
Practice Address - Country:US
Practice Address - Phone:503-784-5843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist