Provider Demographics
NPI:1265694780
Name:MCGINNIS, COLLEEN C (PT, DPT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:C
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3278
Mailing Address - Country:US
Mailing Address - Phone:503-723-5049
Mailing Address - Fax:503-655-9305
Practice Address - Street 1:2001 NW 19TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209
Practice Address - Country:US
Practice Address - Phone:503-723-5049
Practice Address - Fax:503-655-9305
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist