Provider Demographics
NPI:1255521670
Name:ALBERTA, KENNETH JOSEPH (ATC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JOSEPH
Last Name:ALBERTA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1258
Mailing Address - Country:US
Mailing Address - Phone:724-852-3295
Mailing Address - Fax:
Practice Address - Street 1:51 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1258
Practice Address - Country:US
Practice Address - Phone:724-852-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000063A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer