Provider Demographics
NPI:1679531172
Name:BAYNE, KENNETH T (PT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:T
Last Name:BAYNE
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 1:53 NAUTILUS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2465
Mailing Address - Country:US
Mailing Address - Phone:609-597-4119
Mailing Address - Fax:609-597-4022
Practice Address - Street 1:53 NAUTILUS DR
Practice Address - Street 2:SUITE A
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2465
Practice Address - Country:US
Practice Address - Phone:609-597-4119
Practice Address - Fax:609-597-4022
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA01330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070166Medicare ID - Type Unspecified