Basic Information
| Provider Information | |||||||||
| NPI: | 1427454065 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WUTOH | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | WORLANYO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT, CKPI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12023 W WINDROSE DR | ||||||||
| Address2: | |||||||||
| City: | EL MIRAGE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853354323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015704006 | ||||||||
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| Practice Location | |||||||||
| Address1: | 520 ROSE LN | ||||||||
| Address2: | |||||||||
| City: | WICKENBURG | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853901447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286843604 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2014 | ||||||||
| LastUpdateDate: | 11/10/2014 | ||||||||
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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 | 9016 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.