Provider Demographics
NPI:1245672831
Name:KANNADY, BOBBY JR (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:
Last Name:KANNADY
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 DIXIELAND DR
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-6091
Mailing Address - Country:US
Mailing Address - Phone:678-613-5943
Mailing Address - Fax:
Practice Address - Street 1:413 DIXIELAND DR
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6091
Practice Address - Country:US
Practice Address - Phone:678-613-5943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist