Provider Demographics
NPI:1841265287
Name:MORIMATSU, KENT TSURUO (PT)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:TSURUO
Last Name:MORIMATSU
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 1:735 SW 158TH AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4952
Mailing Address - Country:US
Mailing Address - Phone:503-597-0035
Mailing Address - Fax:503-296-2985
Practice Address - Street 1:735 SW 158TH AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4952
Practice Address - Country:US
Practice Address - Phone:503-597-0035
Practice Address - Fax:503-296-2985
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR520244002OtherREGENCE
OR5015OtherPT LICENCE
OR520244002OtherREGENCE