Provider Demographics
NPI:1487028486
Name:KENNEDY WHITE & RIGGS ORTHOPEDIC ASSOCIATES
Entity Type:Organization
Organization Name:KENNEDY WHITE & RIGGS ORTHOPEDIC ASSOCIATES
Other - Org Name:KENNEDY-WHITE ORTHOPAEDIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-961-4128
Mailing Address - Street 1:11025 SUNSET RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4871
Mailing Address - Country:US
Mailing Address - Phone:561-685-8065
Mailing Address - Fax:
Practice Address - Street 1:6050 CATTLERIDGE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6028
Practice Address - Country:US
Practice Address - Phone:941-951-0706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-15
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30780208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty