Provider Demographics
NPI:1285863092
Name:HANSON, KEVIN APPLIN (DPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:APPLIN
Last Name:HANSON
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 1:11481 SW HALL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:19255 SW 65TH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7451
Practice Address - Country:US
Practice Address - Phone:503-692-4934
Practice Address - Fax:503-691-9655
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00805523OtherRR MEDICARE
OR0252263OtherWASHINGTON L & I
OR5000608713Medicaid
OR5000608713Medicaid
OR0252263OtherWASHINGTON L & I