Provider Demographics
NPI:1306392147
Name:JARVIS, KEVIN ALLEN (DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALLEN
Last Name:JARVIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19721 S HIGHWAY 213
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4190
Mailing Address - Country:US
Mailing Address - Phone:503-305-8455
Mailing Address - Fax:
Practice Address - Street 1:19721 S HIGHWAY 213
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4190
Practice Address - Country:US
Practice Address - Phone:503-305-8455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist