Provider Demographics
NPI:1013292085
Name:KENNEDY, ROSEANN R (PT)
Entity Type:Individual
Prefix:
First Name:ROSEANN
Middle Name:R
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 1:9 FARMSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7611
Mailing Address - Country:US
Mailing Address - Phone:845-913-6752
Mailing Address - Fax:845-565-8710
Practice Address - Street 1:9 FARMSTEAD RD
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7611
Practice Address - Country:US
Practice Address - Phone:845-913-6752
Practice Address - Fax:845-565-8710
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005985-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist