Provider Demographics
NPI:1386173169
Name:COLEBANK, KRISTINA (DPT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:COLEBANK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6434 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-1834
Mailing Address - Country:US
Mailing Address - Phone:415-342-9261
Mailing Address - Fax:
Practice Address - Street 1:4829 NE MARTIN LUTHER KING JR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3491
Practice Address - Country:US
Practice Address - Phone:503-283-8133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician