Provider Demographics
NPI:1891349213
Name:KENNY, ELI (DPT)
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:
Last Name:KENNY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 S 7700 E
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84317-9719
Mailing Address - Country:US
Mailing Address - Phone:801-920-6886
Mailing Address - Fax:
Practice Address - Street 1:336 SOUTH 4155 WEST
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120
Practice Address - Country:US
Practice Address - Phone:801-964-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11309456-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist