Provider Demographics
NPI:1790920007
Name:KENNEDY, LESLEY RENEE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:LESLEY
Middle Name:RENEE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3006
Mailing Address - Country:US
Mailing Address - Phone:814-889-9657
Mailing Address - Fax:
Practice Address - Street 1:20 LOCUST ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3006
Practice Address - Country:US
Practice Address - Phone:814-889-9657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0040582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer