Healthcare Provider Details

I. General information

NPI: 1336289685
Provider Name (Legal Business Name): KENNY SARGENT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 N LITCHFIELD RD SUITE 115
GOODYEAR AZ
85395-1252
US

IV. Provider business mailing address

9097 E DESERT COVE AVE SUITE 110
SCOTTSDALE AZ
85260-6279
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-0734
  • Fax: 623-935-0934
Mailing address:
  • Phone: 480-860-4298
  • Fax: 480-860-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7585
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: