Provider Demographics
NPI:1023468097
Name:GANSEN, VALERIE ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:ELIZABETH
Last Name:GANSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:ELIZABETH
Other - Last Name:KACZOWKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:86460 KINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9062
Mailing Address - Country:US
Mailing Address - Phone:541-844-6457
Mailing Address - Fax:
Practice Address - Street 1:4560 SE INTERNATIONAL WAY
Practice Address - Street 2:STE 100
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-4628
Practice Address - Country:US
Practice Address - Phone:971-206-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist