Kevin Blaine Bingham, PTA
Physical Therapy Assistant in Sublimity, OR. Individual provider (NPI-1).
NPI number1679078331
StatusActive
Last updated in NPPESMar 26, 2018
Details
- NPI
- 1679078331
- Entity type
- Individual (NPI-1)
- Name
- Kevin Blaine Bingham
- Credential
- PTA
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 26, 2018
- Last updated
- Mar 26, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225200000X | Physical Therapy Assistant | 09469 | OR | Yes |
| 225200000X | Physical Therapy Assistant | 8177960-2402 | UT |
Practice location
390 Se Church StSublimity, OR 97385-9714
Phone 801-550-5329
Mailing address
1036 Limelight Ave NwSalem, OR 97304-3427
Phone 801-550-5329
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