Provider Demographics
NPI:1043672322
Name:KENNEY, ANN (PTA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:KENNEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 S MAIN AVE STE D
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3352
Mailing Address - Country:US
Mailing Address - Phone:760-728-8999
Mailing Address - Fax:760-728-0821
Practice Address - Street 1:746 S MAIN AVE STE D
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3352
Practice Address - Country:US
Practice Address - Phone:760-728-8999
Practice Address - Fax:760-728-0821
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT10146225200000X
CA71580901082255A2300X
CA18340225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist