Provider Demographics
NPI:1568682359
Name:KLUIT, TANJA A E (PHYSICAL THERAPY AS)
Entity type:Individual
Prefix:MRS
First Name:TANJA
Middle Name:A E
Last Name:KLUIT
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY AS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:3406 NW THATCHER RD
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97716
Mailing Address - Country:US
Mailing Address - Phone:503-357-1254
Mailing Address - Fax:503-992-0169
Practice Address - Street 1:335 SE 8TH AVE
Practice Address - Street 2:TUALITY HOSPTIAL
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4246
Practice Address - Country:US
Practice Address - Phone:503-681-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR7492225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant