Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kenny Gaston

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1205302973

Kenny Gaston is a Physical Therapist in Private Practice in Mitchellville, Maryland. Qualified in 2019, 7 years ago. Practices with Sports Pro Physical Therapy East, a 2-clinician group and accepts Medicare assignment.

Years since qualifying
7
In the registry since
2018
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

12158 Central Ave
Mitchellville, MD 20721-1932
Phone: (301) 430-2750
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1205302973
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedOctober 19, 2018
Last updated in NPPESOctober 19, 2018
Mailing address1306 Twig Ter, Silver Spring, MD 20905-7038

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Sports Pro Physical Therapy East — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Mitchellville