MEDICARE: MS. SASHA LAUREL KOLBECK MPT

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	3702	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	R0000WFBTV	OTHER	OR	MEDICARE GROUP PIN NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	930635514	OTHER	OR	GROUP TAX NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972575728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SASHA LAUREL KOLBECK MPT

Provider Business Mailing Address
First Line	:	1515 NW 18TH AVE
Second Line	:	STE 400
City	:	PORTLAND
State	:	OR
Zip	:	97209-2516
Country	:	US
Telephone Number	:	541-297-2497
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 NW 18TH AVE
Second Line	:	STE 400
City	:	PORTLAND
State	:	OR
Zip	:	97209-2516
Country	:	US
Telephone Number	:	541-297-2497
Fax Number	:

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	04/24/2013

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