Provider Demographics
NPI:1447568183
Name:KAB PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:KAB PHYSICAL THERAPY LLC
Other - Org Name:IMPACT PHYSICAL THERAPY OF HILLSBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-615-5969
Mailing Address - Street 1:4950 NE BELKNAP CT STE 107
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5114
Mailing Address - Country:US
Mailing Address - Phone:503-615-5969
Mailing Address - Fax:503-615-5971
Practice Address - Street 1:4950 NE BELKNAP CT STE 107
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5114
Practice Address - Country:US
Practice Address - Phone:503-615-5969
Practice Address - Fax:503-615-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR157521Medicare PIN