Provider Demographics
NPI:1982203840
Name:DELPHONSE, KERVINS (PT, DPT)
Entity type:Individual
Prefix:
First Name:KERVINS
Middle Name:
Last Name:DELPHONSE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NW 67TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-4011
Mailing Address - Country:US
Mailing Address - Phone:786-547-7237
Mailing Address - Fax:
Practice Address - Street 1:663 JORDAN ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4748
Practice Address - Country:US
Practice Address - Phone:318-222-8882
Practice Address - Fax:318-222-8893
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36227225100000X
LA11746R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist