Healthcare Provider Details

I. General information

NPI: 1508282682
Provider Name (Legal Business Name): KRISTINA GANTER PT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 LAWRENCE ST
EUGENE OR
97401-3440
US

IV. Provider business mailing address

PO BOX 5541
EUGENE OR
97405-0541
US

V. Phone/Fax

Practice location:
  • Phone: 541-284-2084
  • Fax: 541-485-1087
Mailing address:
  • Phone: 541-284-2084
  • Fax: 541-485-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1862
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: KRISTINA W GANTER
Title or Position: OWNER
Credential: PHYSICAL THERAPIST
Phone: 541-284-2084