Provider Demographics
NPI:1700138856
Name:O'HALLORAN, KRISTEN Z GRBAVAC (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:Z GRBAVAC
Last Name:O'HALLORAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ZAROSINSKI
Other - Last Name:GRBAVAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1515 PORTLAND ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132
Mailing Address - Country:US
Mailing Address - Phone:503-537-1462
Mailing Address - Fax:503-537-1808
Practice Address - Street 1:1515 PORTLAND ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132
Practice Address - Country:US
Practice Address - Phone:503-537-1462
Practice Address - Fax:503-537-1808
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009008225100000X
ORPT04909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist