Provider Demographics
NPI:1457481632
Name:MARCHESE-KENNEDY, SHARI L (MPT)
Entity Type:Individual
Prefix:MS
First Name:SHARI
Middle Name:L
Last Name:MARCHESE-KENNEDY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1343
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48347-1343
Mailing Address - Country:US
Mailing Address - Phone:410-796-8499
Mailing Address - Fax:877-384-9028
Practice Address - Street 1:9256 BENDIX RD
Practice Address - Street 2:STE 105/106
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1840
Practice Address - Country:US
Practice Address - Phone:410-796-8499
Practice Address - Fax:877-384-9028
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD173892251P0200X
MI55010111272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics