Provider Demographics
NPI:1639887136
Name:KENEALLY PHYSICAL THERAPY & HOLISTIC HEALING
Entity Type:Organization
Organization Name:KENEALLY PHYSICAL THERAPY & HOLISTIC HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:KENEALLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:781-883-0190
Mailing Address - Street 1:14446 PINE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-9157
Mailing Address - Country:US
Mailing Address - Phone:781-883-0190
Mailing Address - Fax:
Practice Address - Street 1:24850 BURNT PINE DR STE 3
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-0905
Practice Address - Country:US
Practice Address - Phone:781-883-0190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy