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Individual

MR. KENNETH LAGUA ADIVINO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PT, MS

Contact information

Practice address
306 STANAFORD RD, BECKLEY, WV 25801-3142
(304) 255-3302
(304) 254-2783
Mailing address
306 STANAFORD RD, BECKLEY, WV 25801-3142
(304) 255-3302
(304) 254-2783

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
4669
NM
225100000X
Physical Therapist
Primary
PT003604
WV

Other

Enumeration date
03/31/2016
Last updated
03/31/2016
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