Individual
KENNETH LANE DURRENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
104 W. RUSTIN ST., GLENNVILLE, GA 30427
(912) 739-4739
Mailing address
104 W RUSTIN ST, GLENNVILLE, GA 30427-1805
(912) 654-2385
(912) 654-2394
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3337
GA
Other
Enumeration date
08/05/2006
Last updated
12/09/2020
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