Provider Demographics
NPI:1255589057
Name:KOSKAMP, ANDREA NOEL (DPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:NOEL
Last Name:KOSKAMP
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 1:443 NE KNOTT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3108
Mailing Address - Country:US
Mailing Address - Phone:971-404-6146
Mailing Address - Fax:
Practice Address - Street 1:443 NE KNOTT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3108
Practice Address - Country:US
Practice Address - Phone:971-983-5206
Practice Address - Fax:971-983-5211
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR05690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist