Provider Demographics
NPI:1962662924
Name:KENNEDY, PATRICIA ANNE (PT)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:ANNE
Last Name:KENNEDY
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 1:725 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-1724
Mailing Address - Country:US
Mailing Address - Phone:732-240-2986
Mailing Address - Fax:
Practice Address - Street 1:725 MADISON AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-1724
Practice Address - Country:US
Practice Address - Phone:732-240-2986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYQA01250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist