Provider Demographics
NPI:1104088590
Name:THOMASON, JAMES KEVIN (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KEVIN
Last Name:THOMASON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4022
Mailing Address - Country:US
Mailing Address - Phone:541-345-8895
Mailing Address - Fax:541-345-8867
Practice Address - Street 1:1603 OAK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4022
Practice Address - Country:US
Practice Address - Phone:541-345-8895
Practice Address - Fax:541-345-8867
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1104088590Medicaid
ORCK111ZMedicare PIN