Provider Demographics
NPI:1861754087
Name:VALENCIA, KELVIN (DPT)
Entity type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:
Last Name:VALENCIA
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 1:453 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2354
Mailing Address - Country:US
Mailing Address - Phone:860-593-8563
Mailing Address - Fax:
Practice Address - Street 1:453 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2354
Practice Address - Country:US
Practice Address - Phone:860-593-8563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009226225100000X
TX1212723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist