Individual
MR. KENNETH BLAKE DEBORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
618 S MAIN ST, REIDSVILLE, NC 27320-5020
(336) 951-4557
Mailing address
1921 NEW GARDEN RD, APT J305, GREENSBORO, NC 27410-2193
(336) 880-1295
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2226
NC
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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