Provider Demographics
NPI:1528207602
Name:HANCOCK, KENNETH BRADLEY (MPT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:BRADLEY
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:919-535-3271
Practice Address - Street 1:3708 FORESTVIEW RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8042
Practice Address - Country:US
Practice Address - Phone:919-786-7434
Practice Address - Fax:919-786-7437
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist