Provider Demographics
NPI:1184696205
Name:CAVIN, JAMES W (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:W
Last Name:CAVIN
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 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:51577 COLUMBIA RIVER HWY
Practice Address - Street 2:SUITE A
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-8409
Practice Address - Country:US
Practice Address - Phone:503-543-0254
Practice Address - Fax:503-543-0259
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1612225100000X
OROR 60095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0330805OtherWA L&I
OR0330835OtherWA L&I
OR500658344Medicaid
NV3402372Medicaid
OR0330817OtherWA L&I
ORR177825Medicare PIN
ORR177823Medicare PIN
OR0330805OtherWA L&I
OR500658344Medicaid
ORR177827Medicare PIN
OR0330835OtherWA L&I
NV38099Medicare ID - Type Unspecified