Basic Information
| Provider Information | |||||||||
| NPI: | 1063804565 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DAO | ||||||||
| FirstName: | KEVIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6774 CHEW AVE | ||||||||
| Address2: | B | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191191918 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2601 HOLME AVE | ||||||||
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| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191522007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153356000 | ||||||||
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| ProviderEnumerationDate: | 02/21/2015 | ||||||||
| LastUpdateDate: | 02/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT024048 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.