Provider Demographics
NPI:1790264281
Name:KENNEY, PAULA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:KENNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 E PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-1120
Mailing Address - Country:US
Mailing Address - Phone:717-781-4799
Mailing Address - Fax:
Practice Address - Street 1:2 WATERFORD PROFESSIONAL CTR STE 6A
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-9198
Practice Address - Country:US
Practice Address - Phone:717-781-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG004607225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist