Provider Demographics
NPI:1760751499
Name:KENNEDY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:KENNEDY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:712-225-2423
Mailing Address - Street 1:701 S 2ND ST
Mailing Address - Street 2:PO BOX 59
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-2178
Mailing Address - Country:US
Mailing Address - Phone:712-225-2423
Mailing Address - Fax:712-225-2621
Practice Address - Street 1:701 S 2ND ST
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-2178
Practice Address - Country:US
Practice Address - Phone:712-225-2423
Practice Address - Fax:712-225-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty