Provider Demographics
NPI:1053353375
Name:CARP, KENJI C (PT)
Entity type:Individual
Prefix:
First Name:KENJI
Middle Name:C
Last Name:CARP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 E 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3785
Mailing Address - Country:US
Mailing Address - Phone:541-653-9696
Mailing Address - Fax:541-653-9669
Practice Address - Street 1:90 E 27TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3785
Practice Address - Country:US
Practice Address - Phone:541-653-9696
Practice Address - Fax:541-653-9669
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPT4030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR131715Medicare PIN
ORR131715Medicare PIN