Individual
MISS KENNETH LOGDONIO POTESTAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
16089 POPPYSEED CIR UNIT 2008, DELRAY BEACH, FL 33484-6314
(561) 713-0812
Mailing address
16089 POPPYSEED CIR UNIT 2008, DELRAY BEACH, FL 33484-6314
(561) 713-0812
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
070022093
IL
Other
Enumeration date
05/04/2016
Last updated
05/04/2016
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