Provider Demographics
NPI:1972031862
Name:RICHTER, KIRSTEN (LMT)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:RICHTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 BEAVERCREEK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4287
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3444 E BLACKLIDGE DR UNIT F
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5780
Practice Address - Country:US
Practice Address - Phone:503-347-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2025-05-06
Deactivation Date:2020-11-14
Deactivation Code:
Reactivation Date:2025-05-06
Provider Licenses
StateLicense IDTaxonomies
AZ24937225700000X
OR23268225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist