Provider Demographics
NPI:1376110031
Name:ALLISON, KENNETH RAY III (DPT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:RAY
Last Name:ALLISON
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8918 BLAKENEY PROFESSIONAL DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6692
Mailing Address - Country:US
Mailing Address - Phone:704-900-8960
Mailing Address - Fax:
Practice Address - Street 1:1030 COPPERFIELD BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:980-777-8031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP208232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic