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General NPI Number Information
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NPI Number | 1285907626
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Entity Type | Individual
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Provider Name | KENNETH DAVID PASTERNAK LPTA
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Gender | Male
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 14260 S DENNY BLVD
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-9448
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Country | US
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Telephone | 623-536-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 822 ROCK LAKE GLN
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City | FORT MILL
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State | SC
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Zip | 29715-6442
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Country | US
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Telephone | 704-517-4273
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 9618A
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 4607
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2083653
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License Number State | TX
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