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NPI Code Detail

MEDICARE: MR. KENNETH JAMES STOCKLEY

MEDICARE: MR. KENNETH JAMES STOCKLEY
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 TherapistPT018115PA

General Provider Information

NPI Number : 1720158272
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENNETH JAMES STOCKLEY
Provider Business Mailing Address
First Line : 406 THEATRE RD
Second Line :
City : CARROLLTOWN
State : PA
Zip : 15722-7700
Country : US
Telephone Number : 814-344-6338
Fax Number :
Provider Business Practice Location Address
First Line : 951 WASHINGTON AVE
Second Line :
City : TYRONE
State : PA
Zip : 16686-1426
Country : US
Telephone Number : 814-684-2610
Fax Number : 814-684-2610
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 07/08/2007

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