Basic Information
| Provider Information | |||||||||
| NPI: | 1184696205 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAVIN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16083 SW UPPER BOONES FERRY RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972247736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002198835 | ||||||||
| FaxNumber: | 5036399699 | ||||||||
| Practice Location | |||||||||
| Address1: | 51577 COLUMBIA RIVER HWY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SCAPPOOSE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970568409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035430254 | ||||||||
| FaxNumber: | 5035430259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 04/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1612 | NV | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | OR 60095 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0330805 | 01 | OR | WA L&I | OTHER | 0330835 | 01 | OR | WA L&I | OTHER | 500658344 | 05 | OR | MEDICAID | 3402372 | 05 | NV | MEDICAID | 0330817 | 01 | OR | WA L&I | OTHER |