Provider Demographics
NPI:1730145715
Name:COX, KEVIN JAMES (PT CSCS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:COX
Suffix:
Gender:M
Credentials:PT CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908
Mailing Address - Country:US
Mailing Address - Phone:509-248-6113
Mailing Address - Fax:509-457-8941
Practice Address - Street 1:3901 CREEKSIDE LOOP
Practice Address - Street 2:STE 102
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-248-6113
Practice Address - Fax:509-457-8941
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8343759Medicaid
WA186245OtherLNI
WAAB11218Medicare ID - Type Unspecified