Provider Demographics
NPI:1366627648
Name:KENNEDY, KAREN D (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:D
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 1:21 GREGORY DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6080
Mailing Address - Country:US
Mailing Address - Phone:802-658-0949
Mailing Address - Fax:802-658-1436
Practice Address - Street 1:21 GREGORY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6080
Practice Address - Country:US
Practice Address - Phone:802-658-0949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist