Provider Demographics
NPI:1639382393
Name:KENNEDY, KATHERINE TERESA (DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:TERESA
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:KENNEDY
Other - Last Name:STIMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:981 INDUSTRIAL ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-4149
Mailing Address - Country:US
Mailing Address - Phone:650-654-1223
Mailing Address - Fax:650-654-1205
Practice Address - Street 1:981 INDUSTRIAL RD
Practice Address - Street 2:ST B
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070
Practice Address - Country:US
Practice Address - Phone:650-299-4398
Practice Address - Fax:650-299-4789
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28765OtherPT LICENSE
CA28765OtherPT LICENSE