Provider Demographics
NPI:1346606357
Name:KENNEDY, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 HUMBOLT AVE
Mailing Address - Street 2:
Mailing Address - City:MOVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51039-8160
Mailing Address - Country:US
Mailing Address - Phone:712-870-3158
Mailing Address - Fax:
Practice Address - Street 1:1182 HUMBOLT AVE
Practice Address - Street 2:
Practice Address - City:MOVILLE
Practice Address - State:IA
Practice Address - Zip Code:51039-8160
Practice Address - Country:US
Practice Address - Phone:712-870-3158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001223225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant