Individual
KENNETH NWOSU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1290 TREMONT ST, BOSTON, MA 02120-3432
(617) 989-3100
(617) 858-2494
Mailing address
1 CREDIT UNION WAY FL 3, RANDOLPH, MA 02368-4633
(781) 961-3370
(781) 961-1291
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
19371
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002071302
MEDICARE PTAN
MA
05
—
110088251A
—
MA
Enumeration date
02/14/2011
Last updated
10/09/2018
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