Provider Demographics
NPI:1487820239
Name:GROSSKOPF, KATY LYNN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:LYNN
Last Name:GROSSKOPF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 SE 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3112
Mailing Address - Country:US
Mailing Address - Phone:503-307-3922
Mailing Address - Fax:
Practice Address - Street 1:1516 SE 43RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3112
Practice Address - Country:US
Practice Address - Phone:503-307-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12738174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist