Provider Demographics
NPI:1376575274
Name:VALENCIA, KENNETH SINDA (RPT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:SINDA
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 BAHIA VISTA ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2600
Mailing Address - Country:US
Mailing Address - Phone:941-951-2663
Mailing Address - Fax:941-552-3311
Practice Address - Street 1:2750 BAHIA VISTA ST
Practice Address - Street 2:STE 100
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2600
Practice Address - Country:US
Practice Address - Phone:941-951-2663
Practice Address - Fax:941-552-3311
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6654XMedicare PIN
FLU6654ZMedicare ID - Type UnspecifiedMCB