Individual
KEVIN CHARLSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1111 NE 99TH AVE STE 300, PORTLAND, OR 97220
(503) 216-5434
(503) 216-5420
Mailing address
2353 N WATTS ST, PORTLAND, OR 97217-6835
(971) 221-3082
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3542
OR
Other
Enumeration date
05/10/2007
Last updated
07/30/2018
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