Provider Demographics
NPI:1326374141
Name:KENNY, MATTHEW LEE (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LEE
Last Name:KENNY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W 39TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-8045
Mailing Address - Country:US
Mailing Address - Phone:308-698-2820
Mailing Address - Fax:308-698-2822
Practice Address - Street 1:615 W 39TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-8045
Practice Address - Country:US
Practice Address - Phone:308-698-2820
Practice Address - Fax:308-698-2822
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist