Provider Demographics
NPI:1215459425
Name:LENNON, KATHRYN (PT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:LENNON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:120 COBLE CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4566
Mailing Address - Country:US
Mailing Address - Phone:407-466-4556
Mailing Address - Fax:
Practice Address - Street 1:3131 DANIELS RD STE 106
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-7013
Practice Address - Country:US
Practice Address - Phone:407-614-0575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT86222081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine