Provider Demographics
NPI:1811039035
Name:SCHMIDT, KEVIN A (MSPT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:A
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 SE 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1201
Mailing Address - Country:US
Mailing Address - Phone:503-453-4993
Mailing Address - Fax:
Practice Address - Street 1:2622 SE 25TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1217
Practice Address - Country:US
Practice Address - Phone:503-453-4993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR44652251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic