| Doctor Name: | MR. KENNETH LAGUA ADIVINO |
| NPI Number: | 1184087793 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT, MS |
| License Number: | 4669 |
| Business Practice Address: | 306 Stanaford Rd Beckley, WV - 258013142 |
| Business Phone Number: | 3042553302 |
| Business Fax Number: | 3042542783 |
| Mailing Address: | 306 Stanaford Rd, BECKLEY |
| State: | WV |
| Postal Code: | 258013142 |
| Phone Number: | 3042553302 |
| Fax Number: | 3042542783 |
| NPI Enumeration Date: | 03/31/2016 |
| NPI Last Update Date: | 03/31/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 4669 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |