Provider Demographics
NPI:1255780961
Name:OVERMAN, KENNETH JAMES (PT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JAMES
Last Name:OVERMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:KEN
Other - Middle Name:
Other - Last Name:OVERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17518 123RD AVE NE
Mailing Address - Street 2:CROWN HILL - SEVEN SPRINGS
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-7973
Mailing Address - Country:US
Mailing Address - Phone:360-435-8784
Mailing Address - Fax:
Practice Address - Street 1:17518 123RD AVE NE
Practice Address - Street 2:CROWN HILL - SEVEN SPRINGS
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-7973
Practice Address - Country:US
Practice Address - Phone:360-435-8784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000022902251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics