Individual
KEVIN BLAINE BINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
390 SE CHURCH ST, SUBLIMITY, OR 97385-9714
(801) 550-5329
Mailing address
1036 LIMELIGHT AVE NW, SALEM, OR 97304-3427
(801) 550-5329
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09469
OR
225200000X
Physical Therapy Assistant
8177960-2402
UT
Other
Enumeration date
03/26/2018
Last updated
03/26/2018
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