Basic Information
| Provider Information | |||||||||
| NPI: | 1235882184 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOKOPH | ||||||||
| FirstName: | KEVIN | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 578 | ||||||||
| Address2: | |||||||||
| City: | TROUTDALE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970600578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034891174 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25500 SE STARK ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | GRESHAM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970308327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033280222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2022 | ||||||||
| LastUpdateDate: | 02/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 64363 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.