Healthcare Provider Details

I. General information

NPI: 1033068291
Provider Name (Legal Business Name): KEVIN DOYAL JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 THOMAS JOHNSON DR
FREDERICK MD
21702-4673
US

IV. Provider business mailing address

501 PROSPECT BLVD APT 27A
FREDERICK MD
21701-6429
US

V. Phone/Fax

Practice location:
  • Phone: 301-732-8440
  • Fax:
Mailing address:
  • Phone: 301-473-6599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6259
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: