Provider Demographics
NPI:1225589278
Name:FALETTA, KENNETH GEORGE (MS, ATC, LAT, PES)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:GEORGE
Last Name:FALETTA
Suffix:
Gender:M
Credentials:MS, ATC, LAT, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 JANET YULMAN WAY
Mailing Address - Street 2:TULANE INSTITUTE OF SPORTS MEDICINE
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5671
Mailing Address - Country:US
Mailing Address - Phone:504-988-8476
Mailing Address - Fax:
Practice Address - Street 1:202 JANET YULMAN WAY
Practice Address - Street 2:TULANE INSTITUTE OF SPORTS MEDICINE
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5671
Practice Address - Country:US
Practice Address - Phone:504-988-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.2004042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer