Individual
KENNETH PIERRE MASCARINAS LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
800 BROAD ST, SUMMERSVILLE, WV 26651-1707
(304) 872-7380
Mailing address
5 SOUTH PKWY, SUTTON, WV 26601-1611
(304) 644-7908
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
003707
WV
2251G0304X
Geriatric Physical Therapist
003707
WV
Other
Enumeration date
02/05/2020
Last updated
02/05/2020
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