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General NPI Number Information
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NPI Number | 1508199670
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Entity Type | Individual
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Provider Name | BENJAMIN JAMES KEVAN DPT
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Gender | Male
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 1804 W UNION AVE SUITE 101
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City | TACOMA
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State | WA
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Zip | 98405-2062
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Country | US
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Telephone | 253-251-2557
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Fax | 253-393-9187
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Provider Business Mailing Address
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Address Line | 11711 NE 12TH ST STE 3A
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City | BELLEVUE
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State | WA
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Zip | 98005-2461
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Country | US
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Telephone | 425-450-9474
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Fax | 425-452-0704
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60096549
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License Number State | WA
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