Provider Demographics
NPI:1295053791
Name:KARAAN, KENNETH MARTIN (PT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:MARTIN
Last Name:KARAAN
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 1:4998 DOVE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0769
Mailing Address - Country:US
Mailing Address - Phone:951-907-7743
Mailing Address - Fax:
Practice Address - Street 1:4998 DOVE VALLEY CT
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-0769
Practice Address - Country:US
Practice Address - Phone:951-907-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist