Healthcare Provider Details

I. General information

NPI: 1396054805
Provider Name (Legal Business Name): SANDRA ARLENE KITZHABER M.S.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 E 13TH AVE C/O EUGENE URGENT CARE
EUGENE OR
97401-4267
US

IV. Provider business mailing address

PO BOX 1377 C/O EUGENE URGENT CARE
EUGENE OR
97440-1377
US

V. Phone/Fax

Practice location:
  • Phone: 541-636-3473
  • Fax: 541-636-3480
Mailing address:
  • Phone: 541-636-3473
  • Fax: 541-636-3480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 3822
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: