Provider Demographics
NPI:1518430651
Name:NDAMBA, KENNEDY (DPT)
Entity Type:Individual
Prefix:
First Name:KENNEDY
Middle Name:
Last Name:NDAMBA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2833
Mailing Address - Country:US
Mailing Address - Phone:978-390-6996
Mailing Address - Fax:857-345-9591
Practice Address - Street 1:1242 RIVER ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2833
Practice Address - Country:US
Practice Address - Phone:978-390-6996
Practice Address - Fax:857-345-9591
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233842251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty