Stack, Kenneth P
Stack, Kenneth P is an individual health care provider with primary practice located at 115 S Saint Marys St Suite A, Raleigh NC 27603-1785. He recently has 4 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Geriatrics, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Sports, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist is his primary health care specialty. Stack, Kenneth P can be contacted via phone (800) 362-0903.Contact Information
Primary practice address
115 S Saint Marys St Suite A
Raleigh NC 27603-1785
Phone: (800) 362-0903
Fax: (866) 434-5096
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | 8899 | North Carolina |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Geriatrics | 2251G0304X | 8899 | North Carolina |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Sports | 2251S0007X | 8899 | North Carolina |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic | 2251X0800X | 8899 | North Carolina |
Profile Details
| NPI number | 1346230489 |
|---|---|
| LBN Legal business name | Stack, Kenneth P |
| Credentials | PT,MS,CSCS |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 27th, 2005 |
| Last updated | Mar 27th, 2010 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1346230489 | NPPES |
| Other | 11337022 | CAQH | |
| MEDICAID | 7212592 | CAQH | |
| Other | 078V4 | CAQH |
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