Provider Demographics
NPI:1922151364
Name:DUHADAWAY, KEVIN ELLIOT (PT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ELLIOT
Last Name:DUHADAWAY
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 1:202 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3129
Mailing Address - Country:US
Mailing Address - Phone:302-888-0333
Mailing Address - Fax:
Practice Address - Street 1:1400 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-1856
Practice Address - Country:US
Practice Address - Phone:302-798-9565
Practice Address - Fax:302-798-0792
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJI-0000187208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation