Provider Demographics
NPI:1497184824
Name:RICE, CAITLIN MARGARET (PT)
Entity Type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:MARGARET
Last Name:RICE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:CAITLIN
Other - Middle Name:MARGARET
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8621 SE RAYMOND CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-3154
Mailing Address - Country:US
Mailing Address - Phone:415-794-2248
Mailing Address - Fax:
Practice Address - Street 1:1111 NE 99TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220
Practice Address - Country:US
Practice Address - Phone:503-216-5419
Practice Address - Fax:503-216-5420
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500664763Medicaid
ORR174273Medicare PIN