Provider Demographics
NPI:1245351428
Name:NOLTE, KENNETH E (PT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:NOLTE
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 1:1521 N CARPENTER RD STE D1
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-1217
Mailing Address - Country:US
Mailing Address - Phone:209-578-3290
Mailing Address - Fax:
Practice Address - Street 1:1521 N CARPENTER RD
Practice Address - Street 2:SUITE D1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1147
Practice Address - Country:US
Practice Address - Phone:209-578-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist