Provider Demographics
NPI:1760377477
Name:SCHOOLEY, KENNEDY GRACE (PT)
Entity type:Individual
Prefix:DR
First Name:KENNEDY
Middle Name:GRACE
Last Name:SCHOOLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 AMBERGLEN CIR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-0057
Mailing Address - Country:US
Mailing Address - Phone:847-302-1100
Mailing Address - Fax:
Practice Address - Street 1:2075 WOZANI OCANKU NW
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1993
Practice Address - Country:US
Practice Address - Phone:952-445-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist