Provider Demographics
NPI:1235882184
Name:TOKOPH, KEVIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:TOKOPH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-0578
Mailing Address - Country:US
Mailing Address - Phone:503-489-1174
Mailing Address - Fax:
Practice Address - Street 1:25500 SE STARK ST STE 103
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8327
Practice Address - Country:US
Practice Address - Phone:503-328-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist