Provider Demographics
NPI:1396054805
Name:KITZHABER, SANDRA ARLENE (MSPT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ARLENE
Last Name:KITZHABER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1377
Mailing Address - Street 2:C/O EUGENE URGENT CARE
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1377
Mailing Address - Country:US
Mailing Address - Phone:541-636-3473
Mailing Address - Fax:541-636-3480
Practice Address - Street 1:598 E 13TH AVE
Practice Address - Street 2:C/O EUGENE URGENT CARE
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4267
Practice Address - Country:US
Practice Address - Phone:541-636-3473
Practice Address - Fax:541-636-3480
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPT 3822225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist