Provider Demographics
NPI:1912565615
Name:MASSEY, JOHN KENNETH (DPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KENNETH
Last Name:MASSEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5216
Mailing Address - Country:US
Mailing Address - Phone:256-456-0563
Mailing Address - Fax:
Practice Address - Street 1:1906 GLENN BLVD SW STE 1200
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3547
Practice Address - Country:US
Practice Address - Phone:256-364-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH9356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist