MEDICARE: KEVIN NAOTAKA ISHITANI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225100000X	Physical Therapist	PT.PT.70069511	WA

General Provider Information

NPI Number	:	1316642887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN NAOTAKA ISHITANI

Provider Business Mailing Address
First Line	:	16083 SW UPPER BOONES FERRY RD STE 300
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97224-7736
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16315 SW BARROWS RD STE 205
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97007-9461
Country	:	US
Telephone Number	:	503-521-0500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	01/13/2026

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Directions to “ KEVIN NAOTAKA ISHITANI ” Practice Location

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