Healthcare Provider Details

I. General information

NPI: 1861036873
Provider Name (Legal Business Name): KENT PHILLIP LLANORA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9251 STONESTREET RD
LOUISVILLE KY
40272-2858
US

IV. Provider business mailing address

104 WATERFORD CIR
FRANKFORT KY
40601-7635
US

V. Phone/Fax

Practice location:
  • Phone: 877-407-3422
  • Fax: 877-407-4329
Mailing address:
  • Phone: 502-330-4742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007838
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: