Individual
KEVIN J. BOURLAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
730 SW BONNETT WAY, BEND, OR 97702-1192
(808) 283-4139
Mailing address
20403 BUTTERMILK, BEND, OR 97702-9490
(808) 283-4139
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5882
OR
225100000X
Physical Therapist
PT-1393
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00F0051570
HMSA BILLING NUMBER
HI
05
—
24488102
—
HI
05
—
500645456
—
OR
Enumeration date
06/07/2006
Last updated
02/01/2016
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