Provider Demographics
NPI:1336867688
Name:KENNEDY, ANNA VICTORIA (PT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:VICTORIA
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 1:75 SHELL ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-2202
Mailing Address - Country:US
Mailing Address - Phone:251-679-0015
Mailing Address - Fax:251-679-0091
Practice Address - Street 1:75 SHELL ST
Practice Address - Street 2:STE 201
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-2202
Practice Address - Country:US
Practice Address - Phone:251-679-0015
Practice Address - Fax:251-679-0091
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH10965261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy