Provider Demographics
NPI:1336558279
Name:RENTENAAR, CAROLINE (PT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:RENTENAAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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 1:16315 SW BARROWS RD STE 205
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-9461
Practice Address - Country:US
Practice Address - Phone:503-521-0500
Practice Address - Fax:503-521-0503
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0329248OtherWA L&I
OR500675884Medicaid
OR0329248OtherWA L&I