Provider Demographics
NPI:1205148830
Name:TRAUTMAN, CHRISTINA A (DPT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:A
Last Name:TRAUTMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:A
Other - Last Name:KUJAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 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 1:318 NE 99TH ST STE B
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-5902
Practice Address - Country:US
Practice Address - Phone:360-571-2195
Practice Address - Fax:360-571-2408
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6272225100000X
WA60324281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00969337OtherRR MEDICARE
OR500623688Medicaid
ORR154389Medicare PIN
ORR154391Medicare PIN