Provider Demographics
NPI:1619141819
Name:KASAMOTO, JEAN (PT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:KASAMOTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 SW POINTER WAY
Mailing Address - Street 2:APT. O
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6389
Mailing Address - Country:US
Mailing Address - Phone:971-404-9197
Mailing Address - Fax:
Practice Address - Street 1:201 NE PARK PLAZA DR
Practice Address - Street 2:SUITE 246
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5808
Practice Address - Country:US
Practice Address - Phone:360-696-1070
Practice Address - Fax:360-737-0200
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist