Provider Demographics
NPI:1609028844
Name:ABBOTT, KENNETH G (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:G
Last Name:ABBOTT
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 1:1331 PRAIRIE AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4867
Mailing Address - Country:US
Mailing Address - Phone:307-637-4617
Mailing Address - Fax:307-637-6568
Practice Address - Street 1:6598 BUTTERCUP DR UNIT 1
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-2289
Practice Address - Country:US
Practice Address - Phone:970-699-2260
Practice Address - Fax:970-514-3519
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-0938225100000X
COPTL.0015273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist