Kevin J. Bourlai, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5882 Issued in OR

Practice address

730 SW Bonnett Way
Bend, OR 97702-1192

Phone

(808) 283-4139

NPI assigned

Jun 7, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Results Neck and Back Therapy LLCGroup PAC ID 7719282946, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Results Neck & Back Therapy LLC

  • Physical Therapy Clinic/Center
  • Bend, OR
  • NPI 1740648245

  Physical Therapist

  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454284800000",
    "number": "1588604649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20403 BUTTERMILK",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977029490",
            "telephone_number": "808-283-4139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 SW BONNETT WAY",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021192",
            "telephone_number": "808-283-4139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURLAI",
        "first_name": "KEVIN",
        "middle_name": "J.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2016-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "HI",
            "license": "PT-1393",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "5882",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500645456",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA BILLING NUMBER",
            "identifier": "00F0051570",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "24488102",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robine Bots, M.S.
• Amy Danielle Bottaro, AUD
• Victoria C Boudinot, M.S.
• Shelby Kathryn Boudreau
• Molly Laura Bourgault, NP
• Bobbi Alison Bourland
• Ileana Bourland, MSOM LICAC
• Daniel Joseph Bourque, D.C.
• Elizabeth Philbin Bouvier, MA
• Catherine Bowen

• Physical Therapist in Bend, OR
• Providers in Bend, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.