Provider Demographics
NPI:1720883671
Name:SERQUINA, KRIZSA NICOLITTE KATIGBAK (PT, DPT)
Entity type:Individual
Prefix:
First Name:KRIZSA NICOLITTE
Middle Name:KATIGBAK
Last Name:SERQUINA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SE 177TH AVE UNIT H83
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1878
Mailing Address - Country:US
Mailing Address - Phone:503-807-1795
Mailing Address - Fax:
Practice Address - Street 1:740 NE DALLAS ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2058
Practice Address - Country:US
Practice Address - Phone:360-834-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61515996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist