Provider Demographics
NPI:1033345517
Name:KINCAID, PATRICK WILLIAM (DPT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:WILLIAM
Last Name:KINCAID
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:MR
Other - First Name:PATRICK
Other - Middle Name:WILLIAM
Other - Last Name:KINCAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:14851 SE 82ND DR
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7624
Mailing Address - Country:US
Mailing Address - Phone:503-698-5500
Mailing Address - Fax:503-557-4871
Practice Address - Street 1:270 N MOLALLA AVE
Practice Address - Street 2:
Practice Address - City:MOLALLA
Practice Address - State:OR
Practice Address - Zip Code:97038-8841
Practice Address - Country:US
Practice Address - Phone:503-698-5500
Practice Address - Fax:503-557-4871
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5935174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist