Basic Information
| Provider Information | |||||||||
| NPI: | 1942318399 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAHL | ||||||||
| FirstName: | CARINA | ||||||||
| MiddleName: | ESTELLA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PETRUCCI | ||||||||
| OtherFirstName: | CARINA | ||||||||
| OtherMiddleName: | ESTELLA | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1480 NE VILLAGE ST | ||||||||
| Address2: | |||||||||
| City: | FAIRVIEW | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970243827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034891174 | ||||||||
| FaxNumber: | 5034891650 | ||||||||
| Practice Location | |||||||||
| Address1: | 1251 NE ELM ST STE 2A | ||||||||
| Address2: | |||||||||
| City: | PRINEVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977543143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414476846 | ||||||||
| FaxNumber: | 5414471243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2006 | ||||||||
| LastUpdateDate: | 10/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501012616 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.