Provider Demographics
NPI:1629221668
Name:GENDRON, KATHLEEN (DPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:GENDRON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 NE BEACON ST
Mailing Address - Street 2:
Mailing Address - City:CASCADE LOCKS
Mailing Address - State:OR
Mailing Address - Zip Code:97014-6637
Mailing Address - Country:US
Mailing Address - Phone:971-258-0503
Mailing Address - Fax:
Practice Address - Street 1:7515 NE AMBASSADOR PL STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-1379
Practice Address - Country:US
Practice Address - Phone:503-261-8599
Practice Address - Fax:503-408-8932
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist