Provider Demographics
NPI:1851751184
Name:HOWARD, KRISTA RAE (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:RAE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:RAE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 21563
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97307-1563
Mailing Address - Country:US
Mailing Address - Phone:503-390-9009
Mailing Address - Fax:503-393-0834
Practice Address - Street 1:4025 CHERRY AVE NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4859
Practice Address - Country:US
Practice Address - Phone:503-390-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist