Basic Information
| Provider Information | |||||||||
| NPI: | 1730145715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COX | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | PT CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 S 62ND AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092486113 | ||||||||
| FaxNumber: | 5094578941 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 CREEKSIDE LOOP | ||||||||
| Address2: | STE 102 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092486113 | ||||||||
| FaxNumber: | 5094578941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 02/22/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00007712 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8343759 | 05 | WA | MEDICAID | 186245 | 01 | WA | LNI | OTHER |