Provider Demographics
NPI:1982675294
Name:PEYTON, KENNETH SAMUEL (DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SAMUEL
Last Name:PEYTON
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HARRIS CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5751
Mailing Address - Country:US
Mailing Address - Phone:831-643-1234
Mailing Address - Fax:831-643-1233
Practice Address - Street 1:5 HARRIS CT
Practice Address - Street 2:SUITE 2
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5751
Practice Address - Country:US
Practice Address - Phone:831-643-1234
Practice Address - Fax:831-643-1233
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT275892251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT275891Medicare ID - Type UnspecifiedPHYSICAL THERAPY