Provider Demographics
NPI:1467775155
Name:WILNER, KENNETH MARK (PT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:MARK
Last Name:WILNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1016 CONTINENTALS WAY
Mailing Address - Street 2:APT 201
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3161
Mailing Address - Country:US
Mailing Address - Phone:650-591-3073
Mailing Address - Fax:650-591-3073
Practice Address - Street 1:1016 CONTINENTALS WAY
Practice Address - Street 2:APT 201
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3161
Practice Address - Country:US
Practice Address - Phone:650-591-3073
Practice Address - Fax:650-591-3073
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA19059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist