Provider Demographics
NPI:1023242880
Name:LEAMAN, KENNETH SCOTT (DPT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:SCOTT
Last Name:LEAMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DONNA DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1628
Mailing Address - Country:US
Mailing Address - Phone:617-835-7283
Mailing Address - Fax:
Practice Address - Street 1:618 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7335
Practice Address - Country:US
Practice Address - Phone:617-847-0066
Practice Address - Fax:617-847-0908
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186372251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic