Healthcare Provider Details

I. General information

NPI: 1255474581
Provider Name (Legal Business Name): KRISTIN JANE ZOSEL MS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N IVY ST
CANBY OR
97013-3704
US

IV. Provider business mailing address

PO BOX 52194 DEPT CODE 960
PHOENIX AZ
85072-2194
US

V. Phone/Fax

Practice location:
  • Phone: 503-263-6786
  • Fax: 503-263-6451
Mailing address:
  • Phone: 503-489-1781
  • Fax: 503-489-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4979
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: