Provider Demographics
NPI:1467647511
Name:KENNEDY, LYMAN JR (PT)
Entity Type:Individual
Prefix:MR
First Name:LYMAN
Middle Name:
Last Name:KENNEDY
Suffix:JR
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 1:1040 ELM AVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3264
Mailing Address - Country:US
Mailing Address - Phone:562-591-4444
Mailing Address - Fax:562-436-7350
Practice Address - Street 1:1040 ELM AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3264
Practice Address - Country:US
Practice Address - Phone:562-591-4444
Practice Address - Fax:562-436-7350
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist