Provider Demographics
NPI:1770350241
Name:STENFERT KROESE, HANS ALBERT (PT MOMT)
Entity type:Individual
Prefix:
First Name:HANS
Middle Name:ALBERT
Last Name:STENFERT KROESE
Suffix:
Gender:M
Credentials:PT MOMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3066
Mailing Address - Country:US
Mailing Address - Phone:503-927-1012
Mailing Address - Fax:
Practice Address - Street 1:460 5TH ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3066
Practice Address - Country:US
Practice Address - Phone:503-927-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04304261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy