Provider Demographics
NPI:1710467949
Name:KEEFER, JOSHUA BRADLEY (DPT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:BRADLEY
Last Name:KEEFER
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 1:2429 SE 61ST LN
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-2940
Mailing Address - Country:US
Mailing Address - Phone:503-269-6890
Mailing Address - Fax:
Practice Address - Street 1:507 NE 47TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2236
Practice Address - Country:US
Practice Address - Phone:503-215-6488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist