Provider Demographics
NPI:1497868012
Name:THOMAS, KATRINA S (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:S
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:STEPHANY-THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:745 HILARY ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6918
Mailing Address - Country:US
Mailing Address - Phone:503-472-0096
Mailing Address - Fax:503-472-0097
Practice Address - Street 1:745 HILARY ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6918
Practice Address - Country:US
Practice Address - Phone:503-472-0096
Practice Address - Fax:503-472-0097
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR135706Medicare PIN