Provider Demographics
NPI:1508629296
Name:PALENA, KEVIN (PT, DPT, MS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:PALENA
Suffix:
Gender:M
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 NEW LONDON RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7009
Mailing Address - Country:US
Mailing Address - Phone:302-453-1588
Mailing Address - Fax:302-453-9705
Practice Address - Street 1:425 NEW LONDON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7009
Practice Address - Country:US
Practice Address - Phone:302-453-1588
Practice Address - Fax:302-453-9705
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0014817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist