Provider Demographics
NPI:1194291765
Name:LORELLO, KEVIN CHARLES
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHARLES
Last Name:LORELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 GEORGIA AVE APT 222A
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3620
Mailing Address - Country:US
Mailing Address - Phone:407-301-7510
Mailing Address - Fax:
Practice Address - Street 1:KENSINGTON PARK
Practice Address - Street 2:3620 LITTLEDALE RD
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895
Practice Address - Country:US
Practice Address - Phone:301-946-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3987225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant