Provider Demographics
NPI:1629363700
Name:KESNER, KAITLYN M (PT)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:M
Last Name:KESNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:M
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 BALTUSROL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-3884
Mailing Address - Country:US
Mailing Address - Phone:304-257-0365
Mailing Address - Fax:
Practice Address - Street 1:41 BALTUSROL DR
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-3884
Practice Address - Country:US
Practice Address - Phone:304-257-0365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH310917085167OtherOH MEDICAID CARESOURCE
OH0058213Medicaid
WV3810021348Medicaid
OH310917085167OtherOH MEDICAID CARESOURCE