Provider Demographics
NPI:1992808778
Name:CERNAK, KRISTIN F (DPT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:F
Last Name:CERNAK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:FREEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25117 SW PARKWAY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9697
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3607 228TH AVE SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-9206
Practice Address - Country:US
Practice Address - Phone:425-313-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist