Provider Demographics
NPI:1013992072
Name:WALZ, KAREN JEAN (PT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:JEAN
Last Name:WALZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:J
Other - Last Name:ELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:413 NW LARCH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1361
Practice Address - Country:US
Practice Address - Phone:541-923-7494
Practice Address - Fax:541-504-9153
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1400225100000X
CA12280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR650012931OtherRR MEDICARE
OR31604Medicaid
ORP00995520OtherRR MEDICARE
OR31604Medicaid
ORR155110Medicare PIN