Provider Demographics
NPI:1194389486
Name:KENNY, DEBRA (PTA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:KENNY
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 1:2599 VENETIAN LN
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-4325
Mailing Address - Country:US
Mailing Address - Phone:224-325-0690
Mailing Address - Fax:
Practice Address - Street 1:2599 VENETIAN LN
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124-4325
Practice Address - Country:US
Practice Address - Phone:224-325-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.003424225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant