Provider Demographics
NPI:1699405142
Name:SAMANTHA KENNERSON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SAMANTHA KENNERSON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:781-864-2181
Mailing Address - Street 1:108 KILLAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-1719
Mailing Address - Country:US
Mailing Address - Phone:781-864-2181
Mailing Address - Fax:
Practice Address - Street 1:108 KILLAM HILL RD
Practice Address - Street 2:
Practice Address - City:BOXFORD
Practice Address - State:MA
Practice Address - Zip Code:01921-1719
Practice Address - Country:US
Practice Address - Phone:781-864-2181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty