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General NPI Number Information
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NPI Number | 1477744605
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Entity Type | Individual
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Provider Name | CHRISTINE MARY PANAGOS PT
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Gender | Female
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 6217 NE 33RD AVE
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City | PORTLAND
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State | OR
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Zip | 97211-7311
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Country | US
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Telephone | 503-784-5843
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 S MANITOU AVE
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City | BOISE
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State | ID
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Zip | 83706-4148
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Country | US
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Telephone | 503-784-5843
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 5157
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License Number State | ID
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