Healthcare Provider Details

I. General information

NPI: 1053739680
Provider Name (Legal Business Name): KENT CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 S ORANGE AVE SUITE B
ORLANDO FL
32806-3037
US

IV. Provider business mailing address

2116 S ORANGE AVE SUITE B
ORLANDO FL
32806-3037
US

V. Phone/Fax

Practice location:
  • Phone: 407-704-8990
  • Fax:
Mailing address:
  • Phone: 407-704-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS12315
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number7198550001
License Number StateFL

VIII. Authorized Official

Name: MRS. ZAHRA KENT
Title or Position: OFFICE MANAGER
Credential:
Phone: 407-704-8990