Provider Demographics
NPI:1295972255
Name:KLEIMAN, GAVIN
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:KLEIMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 ASHLAND ST
Mailing Address - Street 2:UNIT 104
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1971
Mailing Address - Country:US
Mailing Address - Phone:541-482-0242
Mailing Address - Fax:541-482-0231
Practice Address - Street 1:2205 ASHLAND ST
Practice Address - Street 2:UNIT 104
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1971
Practice Address - Country:US
Practice Address - Phone:541-482-0242
Practice Address - Fax:541-482-0231
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4847225100000X
CA19511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist