Healthcare Provider Details

I. General information

NPI: 1982962700
Provider Name (Legal Business Name): TRISHA KEIKO KOSLOFF DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 BEVERLY ST STE B
SPRINGFIELD OR
97477-1910
US

IV. Provider business mailing address

PO BOX 1648
EUGENE OR
97440-1648
US

V. Phone/Fax

Practice location:
  • Phone: 541-780-6654
  • Fax: 541-780-6645
Mailing address:
  • Phone: 541-687-4900
  • Fax: 541-687-4904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5728
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: