Provider Demographics
NPI:1700860178
Name:DOTTO, KENNETH M (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:DOTTO
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 1:500 MARKET ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2998
Mailing Address - Country:US
Mailing Address - Phone:724-728-7550
Mailing Address - Fax:724-728-6448
Practice Address - Street 1:4538 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1364
Practice Address - Country:US
Practice Address - Phone:814-864-6650
Practice Address - Fax:814-866-2595
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007652850005Medicaid
PA1007652850005Medicaid