Provider Demographics
NPI:1124719299
Name:CALWELL, KASEY REED (PT, DPT, MBA)
Entity type:Individual
Prefix:DR
First Name:KASEY
Middle Name:REED
Last Name:CALWELL
Suffix:
Gender:M
Credentials:PT, DPT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 N MISSISSIPPI AVE APT 406
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-2066
Mailing Address - Country:US
Mailing Address - Phone:360-977-3523
Mailing Address - Fax:
Practice Address - Street 1:3309 N MISSISSIPPI AVE APT 406
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-2066
Practice Address - Country:US
Practice Address - Phone:360-977-3523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64942225100000X, 2251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist