Provider Demographics
NPI:1346398617
Name:KENNEDY, MICHAEL P (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S 500 E STE 150
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2058
Mailing Address - Country:US
Mailing Address - Phone:801-595-1700
Mailing Address - Fax:
Practice Address - Street 1:230 S 500 E STE 150
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84102-2058
Practice Address - Country:US
Practice Address - Phone:801-595-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT285548-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist