Provider Demographics
NPI:1295492114
Name:SAPPLETON, KENRICK SEBASTIAN
Entity type:Individual
Prefix:
First Name:KENRICK
Middle Name:SEBASTIAN
Last Name:SAPPLETON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3592 SW 68TH WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6024
Mailing Address - Country:US
Mailing Address - Phone:954-210-0783
Mailing Address - Fax:
Practice Address - Street 1:3592 SW 68TH WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6024
Practice Address - Country:US
Practice Address - Phone:954-210-0783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-27
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant