Provider Demographics
NPI:1699796748
Name:FLEIT, KEN MICHAEL (PT)
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:MICHAEL
Last Name:FLEIT
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 1:13421 LOCKSLEY LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1048
Mailing Address - Country:US
Mailing Address - Phone:301-881-2273
Mailing Address - Fax:
Practice Address - Street 1:4961 NICHOLSON CT
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1004
Practice Address - Country:US
Practice Address - Phone:301-881-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist