Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | P16460 | NC |
NPI | 1124579685 |
---|---|
Provider Name | Andrew Kenas |
First Address | Charlotte, NC 28203-4104 |
Second Address | Charlotte, NC 28217-3035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2016 |
Last Update Date | 21/12/2020 |