Provider Demographics
NPI:1013316041
Name:KENNEDY, KATHERINE (PT, DPT,CSCS,PMA-CPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PT, DPT,CSCS,PMA-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FREEDOM PARKWAY, SUITE E
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312
Mailing Address - Country:US
Mailing Address - Phone:984-215-3260
Mailing Address - Fax:
Practice Address - Street 1:75 FREEDOM PARKWAY, SUITE E
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312
Practice Address - Country:US
Practice Address - Phone:984-215-3260
Practice Address - Fax:984-215-3261
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist