Provider Demographics
NPI:1396728689
Name:KRISTINE J SPENCER
Entity type:Organization
Organization Name:KRISTINE J SPENCER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-682-7565
Mailing Address - Street 1:8890 SW HOLLY LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9773
Mailing Address - Country:US
Mailing Address - Phone:503-682-7565
Mailing Address - Fax:503-682-8750
Practice Address - Street 1:8890 SW HOLLY LN
Practice Address - Street 2:SUITE B
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9773
Practice Address - Country:US
Practice Address - Phone:503-682-7565
Practice Address - Fax:503-682-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR105925Medicare PIN