Provider Demographics
NPI:1134599632
Name:HOLBERT, KENNETH SR
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:HOLBERT
Suffix:SR
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 1:5450 MACDONALD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-5906
Mailing Address - Country:US
Mailing Address - Phone:305-294-8866
Mailing Address - Fax:305-294-8898
Practice Address - Street 1:5450 MACDONALD AVE STE 1
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-5906
Practice Address - Country:US
Practice Address - Phone:305-294-8866
Practice Address - Fax:305-294-8898
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 1739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist