Provider Demographics
NPI:1912235649
Name:STOKES, KENNETH FREDERICK (DPT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:FREDERICK
Last Name:STOKES
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 1:653 SUMMER ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-2108
Mailing Address - Country:US
Mailing Address - Phone:617-269-6262
Mailing Address - Fax:617-269-1068
Practice Address - Street 1:653 SUMMER ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-2108
Practice Address - Country:US
Practice Address - Phone:617-269-6262
Practice Address - Fax:617-269-1068
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18828174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist