Provider Demographics
NPI:1063572303
Name:MOUNT, KENNITH SCOTT (PT)
Entity type:Individual
Prefix:
First Name:KENNITH
Middle Name:SCOTT
Last Name:MOUNT
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 1:1403 W BYPASS
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-5241
Mailing Address - Country:US
Mailing Address - Phone:334-427-3037
Mailing Address - Fax:
Practice Address - Street 1:105 S WHALEY ST
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-2105
Practice Address - Country:US
Practice Address - Phone:334-493-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL95857Medicare UPIN