Provider Demographics
NPI:1578110763
Name:VALDOVINOS, KENNA JOSEPHINE (DPT)
Entity Type:Individual
Prefix:
First Name:KENNA
Middle Name:JOSEPHINE
Last Name:VALDOVINOS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1779 RED CEDAR DR APT 17
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7632
Mailing Address - Country:US
Mailing Address - Phone:046-106-2589
Mailing Address - Fax:
Practice Address - Street 1:1402 SE 16TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3819
Practice Address - Country:US
Practice Address - Phone:239-772-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL34871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist