Provider Demographics
NPI:1508282682
Name:KRISTINA GANTER PT
Entity Type:Organization
Organization Name:KRISTINA GANTER PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:W
Authorized Official - Last Name:GANTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:541-284-2084
Mailing Address - Street 1:PO BOX 5541
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0541
Mailing Address - Country:US
Mailing Address - Phone:541-284-2084
Mailing Address - Fax:541-485-1087
Practice Address - Street 1:1034 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3440
Practice Address - Country:US
Practice Address - Phone:541-284-2084
Practice Address - Fax:541-485-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty