Provider Demographics
NPI:1114031978
Name:KENNEDY, LINDA ANN (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:KENNEDY
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 1:4244 COUNTYLINE ROAD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021
Mailing Address - Country:US
Mailing Address - Phone:315-685-1150
Mailing Address - Fax:
Practice Address - Street 1:2109 RTS 5 20
Practice Address - Street 2:ORTHOPEDICS PLUS
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148
Practice Address - Country:US
Practice Address - Phone:315-568-2249
Practice Address - Fax:315-568-1857
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0081891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist