Provider Demographics
NPI:1386372498
Name:NAVIA, CARLOS JON PAUL GEORGE (DPT)
Entity type:Individual
Prefix:
First Name:CARLOS JON PAUL
Middle Name:GEORGE
Last Name:NAVIA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:GEORGE
Other - Last Name:NAVIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1734 N TERRY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-6543
Mailing Address - Country:US
Mailing Address - Phone:971-207-2341
Mailing Address - Fax:
Practice Address - Street 1:1734 N TERRY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-6543
Practice Address - Country:US
Practice Address - Phone:971-207-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist