Provider Demographics
NPI:1053515148
Name:THEUS, KESNEL (DOM)
Entity type:Individual
Prefix:
First Name:KESNEL
Middle Name:
Last Name:THEUS
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 PALAIS TER
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33467-8063
Mailing Address - Country:US
Mailing Address - Phone:561-929-7711
Mailing Address - Fax:954-429-0223
Practice Address - Street 1:4845 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-4861
Practice Address - Country:US
Practice Address - Phone:954-429-0223
Practice Address - Fax:954-429-1063
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAP 2382171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist