Provider Demographics
NPI:1780677658
Name:KEARNEY, PATRICIA JO (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JO
Last Name:KEARNEY
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 1:6901 ELKRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413
Mailing Address - Country:US
Mailing Address - Phone:575-206-6597
Mailing Address - Fax:866-927-9655
Practice Address - Street 1:4410 50TH ST.
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414
Practice Address - Country:US
Practice Address - Phone:575-206-6597
Practice Address - Fax:866-927-9655
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00Q018OtherBLUE CROSS BLUE SHIELD
NM79286Medicaid