Provider Demographics
NPI:1073825626
Name:KENNEDY, AMANDA CONGLETON (DPT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:CONGLETON
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:CONGLETON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7285
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:4027 HILLSBORO PIKE STE 801
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2734
Practice Address - Country:US
Practice Address - Phone:615-385-2201
Practice Address - Fax:615-383-8590
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist