MEDICARE: KRISTINA COLEBANK DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1386173169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA COLEBANK DPT

Provider Business Mailing Address
First Line	:	6434 N MICHIGAN AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-1834
Country	:	US
Telephone Number	:	415-342-9261
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 NE MARTIN LUTHER KING JR
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-3491
Country	:	US
Telephone Number	:	503-283-8133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	03/10/2024

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Directions to “ KRISTINA COLEBANK DPT” Practice Location

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