Provider Demographics
NPI:1801585864
Name:KENNEDY, TRAVIS (DPT)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 FLETCHER AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1357
Mailing Address - Country:US
Mailing Address - Phone:402-741-2545
Mailing Address - Fax:
Practice Address - Street 1:510 BRADFORD ST
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-1708
Practice Address - Country:US
Practice Address - Phone:402-646-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist