Active NPI
Kevin Charlston, PT
- Physical Therapist
- Portland, OR
National Provider Identifier
1437363942
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3542
- Practice address
- 1111 NE 99TH Ave Ste 300
Portland, OR 97220 - Phone
- (503) 216-5434
- Fax
- (503) 216-5420
- NPI assigned
- May 10, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3542 | OR | Primary |
Addresses
Primary practice location
1111 NE 99TH Ave Ste 300
Portland, OR 97220
Mailing address
2353 N Watts St
Portland, OR 97217-6835
Phone (971) 221-3082
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3542 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532908800000",
"number": "1437363942",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2353 N WATTS ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972176835",
"telephone_number": "971-221-3082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 NE 99TH AVE STE 300",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97220",
"telephone_number": "503-216-5434",
"fax_number": "503-216-5420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHARLSTON",
"first_name": "KEVIN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-10",
"last_updated": "2018-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "3542",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.