Provider Demographics
NPI:1922134964
Name:KENNEDY, CHRISTOPHER DALE (PT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DALE
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-6060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 PEEKSKILL HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-3248
Practice Address - Country:US
Practice Address - Phone:845-528-3133
Practice Address - Fax:845-528-0463
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist