Provider Demographics
NPI:1811458771
Name:CARSTENSEN, THOR (LMT)
Entity type:Individual
Prefix:
First Name:THOR
Middle Name:
Last Name:CARSTENSEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:
Other - Last Name:CARSTENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5253 NE SANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2562
Mailing Address - Country:US
Mailing Address - Phone:503-893-5131
Mailing Address - Fax:503-914-0923
Practice Address - Street 1:5253 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2562
Practice Address - Country:US
Practice Address - Phone:503-893-5131
Practice Address - Fax:503-914-0923
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
OR26600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR26600OtherSTATE LICENSE