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General NPI Number Information
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NPI Number | 1457742777
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Entity Type | Individual
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Provider Name | CACHE D KENNINGTON DPT
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Gender | Male
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 67 DOC PERKES
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City | AFTON
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State | WY
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Zip | 83110-7703
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Country | US
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Telephone | 307-883-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 901 ADAMS ST
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City | AFTON
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State | WY
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Zip | 83110-9621
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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