Provider Demographics
NPI:1629237029
Name:MCVAY, KRISTIN L (MSPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:MCVAY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1806
Mailing Address - Country:US
Mailing Address - Phone:503-538-2108
Mailing Address - Fax:503-538-1768
Practice Address - Street 1:1900 FULTON ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1806
Practice Address - Country:US
Practice Address - Phone:503-538-2108
Practice Address - Fax:503-538-1768
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR44612251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics