Provider Demographics
NPI:1790812097
Name:KANE, PAUL STEPHEN (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:STEPHEN
Last Name:KANE
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 1:6464 SW BORLAND RD
Mailing Address - Street 2:SUITE B5
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8876
Mailing Address - Country:US
Mailing Address - Phone:503-699-2955
Mailing Address - Fax:503-699-2703
Practice Address - Street 1:6464 SW BORLAND RD
Practice Address - Street 2:SUITE B5
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8876
Practice Address - Country:US
Practice Address - Phone:503-699-2955
Practice Address - Fax:503-699-2703
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR059142001OtherBCBS
OR072087Medicaid
OR204243Medicaid
OR204243Medicaid