Provider Demographics
NPI:1578769881
Name:DELVA, KESNEL (PTA)
Entity Type:Individual
Prefix:
First Name:KESNEL
Middle Name:
Last Name:DELVA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11334 MAJESTIC ACRES TER
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-7808
Mailing Address - Country:US
Mailing Address - Phone:561-738-0848
Mailing Address - Fax:
Practice Address - Street 1:315 CADIMA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-7307
Practice Address - Country:US
Practice Address - Phone:305-219-9030
Practice Address - Fax:305-437-8045
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA2085225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant