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NPI Code Detail

MEDICARE: KENNA JOSEPHINE VALDOVINOS DPT

MEDICARE: KENNA JOSEPHINE VALDOVINOS DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist34871FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578110763
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNA JOSEPHINE VALDOVINOS DPT
Provider Business Mailing Address
First Line : 1779 RED CEDAR DR APT 17
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-7632
Country : US
Telephone Number : 46-106-2589
Fax Number :
Provider Business Practice Location Address
First Line : 1402 SE 16TH PL
Second Line :
City : CAPE CORAL
State : FL
Zip : 33990-3819
Country : US
Telephone Number : 239-772-2363
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2019
Last Update Date : 08/22/2019

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Directions to “ KENNA JOSEPHINE VALDOVINOS DPT” Practice Location

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