Provider Demographics
NPI:1982398616
Name:KENN, KARA MARIE (MSPT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:MARIE
Last Name:KENN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-2054
Mailing Address - Country:US
Mailing Address - Phone:508-378-4035
Mailing Address - Fax:
Practice Address - Street 1:650 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-2054
Practice Address - Country:US
Practice Address - Phone:508-378-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist