Provider Demographics
NPI:1851663678
Name:KENT, ALEXANDER G
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:G
Last Name:KENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11330 MAPLE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2080
Mailing Address - Country:US
Mailing Address - Phone:502-426-2221
Mailing Address - Fax:502-426-2210
Practice Address - Street 1:11330 MAPLE BROOK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2080
Practice Address - Country:US
Practice Address - Phone:502-426-2221
Practice Address - Fax:502-426-2210
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist