Provider Demographics
NPI:1881377182
Name:KENNEDY, YUJIAN KATHLEEN (DPT)
Entity type:Individual
Prefix:
First Name:YUJIAN
Middle Name:KATHLEEN
Last Name:KENNEDY
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 1:4858 TANGERINE CIR
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2418
Mailing Address - Country:US
Mailing Address - Phone:864-385-0597
Mailing Address - Fax:
Practice Address - Street 1:3919 CARTER RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1628
Practice Address - Country:US
Practice Address - Phone:770-614-5772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist