Provider Demographics
NPI:1912218603
Name:KAWAGUCHI, JEFFREY KEITH (PT, PHD, ATC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KEITH
Last Name:KAWAGUCHI
Suffix:
Gender:M
Credentials:PT, PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PHYSICAL EDUCATION BUILDING
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-2476
Mailing Address - Country:US
Mailing Address - Phone:509-359-7967
Mailing Address - Fax:509-359-4833
Practice Address - Street 1:200 PHYSICAL EDUCATION BUILDING
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-2476
Practice Address - Country:US
Practice Address - Phone:509-359-7967
Practice Address - Fax:509-359-4833
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000039082251X0800X
WAA1 00472962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic