Provider Demographics
NPI:1316480304
Name:VAN VLEET, KEVIN JEFFREY (PT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JEFFREY
Last Name:VAN VLEET
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 1:3121 W KENNEWICK AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2921
Mailing Address - Country:US
Mailing Address - Phone:509-735-7433
Mailing Address - Fax:509-735-6577
Practice Address - Street 1:3121 W KENNEWICK AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2921
Practice Address - Country:US
Practice Address - Phone:509-735-7433
Practice Address - Fax:509-735-6577
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60660135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist