Provider Demographics
NPI:1942318399
Name:KAHL, CARINA ESTELLA (DPT)
Entity type:Individual
Prefix:MRS
First Name:CARINA
Middle Name:ESTELLA
Last Name:KAHL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:CARINA
Other - Middle Name:ESTELLA
Other - Last Name:PETRUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1480 NE VILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-3827
Mailing Address - Country:US
Mailing Address - Phone:503-489-1174
Mailing Address - Fax:503-489-1650
Practice Address - Street 1:1251 NE ELM ST STE 2A
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-3143
Practice Address - Country:US
Practice Address - Phone:541-447-6846
Practice Address - Fax:541-447-1243
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN14720005Medicare PIN