Healthcare Provider Details

I. General information

NPI: 1174562938
Provider Name (Legal Business Name): LORALEE RUTH HANSEN RKT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SW US VETERANS HOSPITAL RD
PORTLAND OR
97239-2964
US

IV. Provider business mailing address

2117 NE AINSWORTH ST
PORTLAND OR
97211-5459
US

V. Phone/Fax

Practice location:
  • Phone: 360-690-0271
  • Fax: 360-750-5382
Mailing address:
  • Phone: 503-249-8381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: