Provider Demographics
NPI:1275075111
Name:CHARLESTON, KENNETH
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:CHARLESTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 POTTSTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-9518
Mailing Address - Country:US
Mailing Address - Phone:610-458-6464
Mailing Address - Fax:610-458-6465
Practice Address - Street 1:708 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-1636
Practice Address - Country:US
Practice Address - Phone:267-932-9177
Practice Address - Fax:267-932-9180
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0256552251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic