Provider Demographics
NPI:1104856566
Name:KENNER, LINDA LEE (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:KENNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 WEDGEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4044
Mailing Address - Country:US
Mailing Address - Phone:972-234-1421
Mailing Address - Fax:972-234-1421
Practice Address - Street 1:3604 BELT LINE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-2424
Practice Address - Country:US
Practice Address - Phone:972-484-9000
Practice Address - Fax:972-484-1121
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1023554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist