Basic Information
| Provider Information | |||||||||
| NPI: | 1275075111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHARLESTON | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 163 POTTSTOWN PIKE | ||||||||
| Address2: | |||||||||
| City: | CHESTER SPRINGS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194259518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104586464 | ||||||||
| FaxNumber: | 6104586465 | ||||||||
| Practice Location | |||||||||
| Address1: | 708 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HARLEYSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194381636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2679329177 | ||||||||
| FaxNumber: | 2679329180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2016 | ||||||||
| LastUpdateDate: | 03/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | PT025655 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | PT025655 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.