Provider Demographics
NPI:1720158272
Name:STOCKLEY, KENNETH JAMES
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JAMES
Last Name:STOCKLEY
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 1:406 THEATRE RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15722-7700
Mailing Address - Country:US
Mailing Address - Phone:814-344-6338
Mailing Address - Fax:
Practice Address - Street 1:951 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1426
Practice Address - Country:US
Practice Address - Phone:814-684-2610
Practice Address - Fax:814-684-2610
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist