Provider Demographics
NPI:1952310989
Name:GILBERT, KEVIN JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:GILBERT
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 1:113 1/2 S. HELBERTA AVENUE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3445
Mailing Address - Country:US
Mailing Address - Phone:310-376-7314
Mailing Address - Fax:
Practice Address - Street 1:3250 LOMITA BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5014
Practice Address - Country:US
Practice Address - Phone:310-539-8800
Practice Address - Fax:310-698-5414
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 23369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist