Provider Demographics
NPI:1013764232
Name:STATLER, KEVIN LYNN
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LYNN
Last Name:STATLER
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 1:107 KENSINGER HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:PA
Mailing Address - Zip Code:16695-9652
Mailing Address - Country:US
Mailing Address - Phone:814-285-7785
Mailing Address - Fax:
Practice Address - Street 1:437 GIVLER DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:PA
Practice Address - Zip Code:16662-1635
Practice Address - Country:US
Practice Address - Phone:814-793-3728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1000573208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation