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General NPI Number Information
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NPI Number | 1033345517
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Entity Type | Individual
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Provider Name | PATRICK WILLIAM KINCAID DPT
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Gender | Male
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 270 N MOLALLA AVE
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City | MOLALLA
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State | OR
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Zip | 97038-8841
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Country | US
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Telephone | 503-698-5500
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Fax | 503-557-4871
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Provider Business Mailing Address
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Address Line | 14851 SE 82ND DR
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City | CLACKAMAS
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State | OR
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Zip | 97015-7624
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Country | US
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Telephone | 503-698-5500
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Fax | 503-557-4871
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5935
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License Number State | OR
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