Healthcare Provider Details

I. General information

NPI: 1134438419
Provider Name (Legal Business Name): KENTON DELL KIRBY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date: 12/21/2011
Reactivation Date: 11/28/2018

III. Provider practice location address

2519 COVE AVE
LA GRANDE OR
97850
US

IV. Provider business mailing address

2519 COVE AVE
LA GRANDE OR
97850
US

V. Phone/Fax

Practice location:
  • Phone: 541-962-0830
  • Fax: 541-975-2720
Mailing address:
  • Phone: 541-962-0830
  • Fax: 541-975-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1064
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60360
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: