Provider Demographics
NPI:1104045947
Name:KENNEDY, RICHARD P (PTSCS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:PTSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BRAINTREE HILL OFFICE PARK
Mailing Address - Street 2:KENNEDY BROTHERS PHYSICAL THERAPY
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-8702
Mailing Address - Country:US
Mailing Address - Phone:781-848-7300
Mailing Address - Fax:781-848-5678
Practice Address - Street 1:25 BRAINTREE HILL OFFICE PARK
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-8702
Practice Address - Country:US
Practice Address - Phone:781-848-7300
Practice Address - Fax:781-848-5678
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist