| Doctor Name: | KENNETH SPORES |
| NPI Number: | 1275564429 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 8262 |
| Business Practice Address: | 304 W Weaver St Ste 103 Carrboro, NC - 275102084 |
| Business Phone Number: | 9199420240 |
| Business Fax Number: | 9199420280 |
| Mailing Address: | 790 Remington Blvd, BOLINGBROOK |
| State: | IL |
| Postal Code: | 604404909 |
| Phone Number: | 6302962223 |
| Fax Number: | 6307599510 |
| NPI Enumeration Date: | 07/05/2006 |
| NPI Last Update Date: | 07/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 8262 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |