Provider Demographics
NPI:1144757485
Name:LAPORTE, KEVAN JOHN (DPT)
Entity Type:Individual
Prefix:
First Name:KEVAN
Middle Name:JOHN
Last Name:LAPORTE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 E. CLAIREMONT AVENUE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6479
Mailing Address - Country:US
Mailing Address - Phone:715-855-0408
Mailing Address - Fax:715-855-0409
Practice Address - Street 1:517 E. CLAIREMONT AVENUE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6479
Practice Address - Country:US
Practice Address - Phone:715-855-0408
Practice Address - Fax:715-855-0409
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WI14040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100072562Medicaid