Provider Demographics
NPI:1568595254
Name:REEVES, KEVIN DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DAVID
Last Name:REEVES
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:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0378
Mailing Address - Country:US
Mailing Address - Phone:928-729-6767
Mailing Address - Fax:928-729-7630
Practice Address - Street 1:WINDOW ROCK SCHOOLS
Practice Address - Street 2:NAVAJO ROUTE 12
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504-0559
Practice Address - Country:US
Practice Address - Phone:928-729-6705
Practice Address - Fax:928-729-5780
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ689804OtherAHCCCS