Provider Demographics
NPI:1588062749
Name:HARMON, KEVIN (DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:HARMON
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 1:24630 WASHINGTON AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6131
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:1922 HACIENDA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6024
Practice Address - Country:US
Practice Address - Phone:760-630-2258
Practice Address - Fax:760-630-5367
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 42064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA143944Medicare PIN
CACA143942Medicare PIN
CACA143948Medicare PIN
CACA143940Medicare PIN
CACA143947Medicare PIN
CACB230438Medicare PIN
CACA143943Medicare PIN
CACA143946Medicare PIN
CACA143945Medicare PIN