Provider Demographics
NPI:1265703623
Name:IGIRIO, KENLLY J (DPT)
Entity type:Individual
Prefix:DR
First Name:KENLLY
Middle Name:J
Last Name:IGIRIO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 COLLETT AVE APT 2523
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3790
Mailing Address - Country:US
Mailing Address - Phone:305-332-5424
Mailing Address - Fax:
Practice Address - Street 1:8655 HAVEN AVE STE 200
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4891
Practice Address - Country:US
Practice Address - Phone:800-642-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist