Provider Demographics
NPI:1669720363
Name:GIRARD, KEVIN JAMES (DPT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JAMES
Last Name:GIRARD
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 1:375 E VIRGINIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1202
Mailing Address - Country:US
Mailing Address - Phone:602-264-0443
Mailing Address - Fax:602-264-9727
Practice Address - Street 1:375 E VIRGINIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1202
Practice Address - Country:US
Practice Address - Phone:602-264-0443
Practice Address - Fax:602-264-9727
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12085-24225100000X
AZ11366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist