Provider Demographics
NPI:1477267649
Name:CONDE APONTE, KENNETH (DPT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:CONDE APONTE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:
Other - Last Name:CONDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 W PIONEER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4917
Practice Address - Country:US
Practice Address - Phone:972-979-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist