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Contact Information

KENNETH P STACK, PT,MS,CSCS
115 S SAINT MARYS ST
SUITE A
RALEIGH, NC27603-1785
 Phone: 800-362-0903
 Fax: 866-434-5096
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physical Therapist

225100000X 65 Physical Therapist in Private Practice
 

Geriatrics

2251G0304X 65 Physical Therapist in Private Practice
 

Orthopedic

2251X0800X 65 Physical Therapist in Private Practice
 

Sports

2251S0007X 65 Physical Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for KENNETH P STACK · (Male)

NPI # 1346230489
Status Active
Credentials PT,MS,CSCS
Entity Individual
Enumeration date 10/27/2005
Last updated 03/27/2010 - About 16 years ago
Sole proprietor 1 No
Identifiers
  • NC License # 8899
  • NC Medicaid 7212592
  • Other 11337022 CAQH
  • NC Other 078V4 BCBS
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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