Provider Demographics
NPI:1649478991
Name:KENNEDY, KATHERINE (PT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
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 1:1965 S ALMA SCHOOL RD
Mailing Address - Street 2:STE 5
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7081
Mailing Address - Country:US
Mailing Address - Phone:480-782-5211
Mailing Address - Fax:480-782-5213
Practice Address - Street 1:1076 W CHANDLER BLVD
Practice Address - Street 2:STE 103
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5225
Practice Address - Country:US
Practice Address - Phone:480-821-1997
Practice Address - Fax:480-821-1887
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7712174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist