Provider Demographics
NPI:1497545461
Name:ANDERTON, KENNEDY (DPT)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:
Last Name:ANDERTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CHENEY DR W
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3721
Mailing Address - Country:US
Mailing Address - Phone:208-329-7667
Mailing Address - Fax:
Practice Address - Street 1:243 CHENEY DR W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3721
Practice Address - Country:US
Practice Address - Phone:208-329-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3171067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist