Healthcare Provider Details

I. General information

NPI: 1508199670
Provider Name (Legal Business Name): BENJAMIN JAMES KEVAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 W UNION AVE SUITE 101
TACOMA WA
98405-2062
US

IV. Provider business mailing address

11711 NE 12TH ST STE 3A
BELLEVUE WA
98005-2461
US

V. Phone/Fax

Practice location:
  • Phone: 253-251-2557
  • Fax: 253-393-9187
Mailing address:
  • Phone: 425-450-9474
  • Fax: 425-452-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60096549
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: