Provider Demographics
NPI:1295917151
Name:LOUD, KENNETH CHARLES (PT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:CHARLES
Last Name:LOUD
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 1:747 VOLVO PKWY
Mailing Address - Street 2:103
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1615
Mailing Address - Country:US
Mailing Address - Phone:757-420-2880
Mailing Address - Fax:
Practice Address - Street 1:747 VOLVO PKWY
Practice Address - Street 2:103
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1615
Practice Address - Country:US
Practice Address - Phone:757-420-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
64-00296OtherUNITED HEALTHCARE
193561OtherANTHEM
2138099OtherFIRST HEALTH
VA615185OtherALLIANCE HMO,EC,MC
615185OtherMAMSI/OPT/MDOPA/ALLIANCE
990011349OtherRAILROAD MEDICARE
57767OtherOPTIMA HEALTH INS
193561OtherHEALTHKEEPERS
3223253OtherAETNA
615185OtherALLIANCE
990011349OtherRAILROAD MEDICARE