Provider Demographics
NPI:1326310483
Name:BRENT, KENYA NETOSHA (MPT)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:NETOSHA
Last Name:BRENT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9440 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3659
Mailing Address - Country:US
Mailing Address - Phone:301-599-8899
Mailing Address - Fax:
Practice Address - Street 1:9440 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3659
Practice Address - Country:US
Practice Address - Phone:301-599-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist