Provider Demographics
NPI:1831578574
Name:DAWES, KENNETH SAMUEL JR (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SAMUEL
Last Name:DAWES
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 WISE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-0715
Mailing Address - Country:US
Mailing Address - Phone:214-226-6831
Mailing Address - Fax:
Practice Address - Street 1:2352 WISE RD
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-0715
Practice Address - Country:US
Practice Address - Phone:214-226-6831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40053225100000X
TX1137859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist