Provider Demographics
NPI:1508110404
Name:BATTAGLIA, KEVIN JOHN
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JOHN
Last Name:BATTAGLIA
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 1:3170 S BLAGG RD
Mailing Address - Street 2:621 S.BLAGG
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-5493
Mailing Address - Country:US
Mailing Address - Phone:774-228-1201
Mailing Address - Fax:
Practice Address - Street 1:3170 S BLAGG RD
Practice Address - Street 2:621 S.BLAGG
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5493
Practice Address - Country:US
Practice Address - Phone:774-228-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJB08324337107612225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner