Provider Demographics
NPI:1851546782
Name:FREEMAN, KENNETH ALAN (DPT)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALAN
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 W 12600 S
Mailing Address - Street 2:# 2B
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7161
Mailing Address - Country:US
Mailing Address - Phone:801-446-7171
Mailing Address - Fax:801-446-7373
Practice Address - Street 1:2332 W 12600 S
Practice Address - Street 2:# 2B
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7161
Practice Address - Country:US
Practice Address - Phone:801-446-7171
Practice Address - Fax:801-446-7373
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT121932-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005712901Medicare UPIN