Provider Demographics
NPI:1285907626
Name:PASTERNAK, KENNETH DAVID (LPTA)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DAVID
Last Name:PASTERNAK
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 ROCK LAKE GLN
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-6442
Mailing Address - Country:US
Mailing Address - Phone:704-517-4273
Mailing Address - Fax:
Practice Address - Street 1:14260 S DENNY BLVD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-9448
Practice Address - Country:US
Practice Address - Phone:623-536-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9618A225200000X
NC4607225200000X
TX2083653225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant