Provider Demographics
NPI:1528001997
Name:FOX, KENNETH (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:FOX
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-2808
Mailing Address - Country:US
Mailing Address - Phone:717-627-1285
Mailing Address - Fax:717-626-0161
Practice Address - Street 1:747 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-2808
Practice Address - Country:US
Practice Address - Phone:717-627-1285
Practice Address - Fax:717-626-0161
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-009369L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS65159Medicare UPIN
PA20485Medicare ID - Type Unspecified