Provider Demographics
NPI:1376641118
Name:HUGHES, KEVIN CHARLES (PT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:CHARLES
Last Name:HUGHES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SHAW AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3841
Mailing Address - Country:US
Mailing Address - Phone:559-299-2244
Mailing Address - Fax:559-299-2487
Practice Address - Street 1:145 SHAW AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3841
Practice Address - Country:US
Practice Address - Phone:559-299-2244
Practice Address - Fax:559-299-2487
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0PT101110Medicare ID - Type Unspecified