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General NPI Number Information
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NPI Number | 1275075111
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Entity Type | Individual
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Provider Name | DR. KENNETH CHARLESTON
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Gender | Male
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Dates
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Enumeration Date | 11/09/2016
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 708 MAIN ST
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City | HARLEYSVILLE
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State | PA
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Zip | 19438-1636
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Country | US
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Telephone | 267-932-9177
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Fax | 267-932-9180
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Provider Business Mailing Address
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Address Line | 163 POTTSTOWN PIKE
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City | CHESTER SPRINGS
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State | PA
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Zip | 19425-9518
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Country | US
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Telephone | 610-458-6464
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Fax | 610-458-6465
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT025655
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT025655
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License Number State | PA
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