Provider Demographics
NPI:1982756854
Name:KENNEDY BROTHERS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:KENNEDY BROTHERS PHYSICAL THERAPY
Other - Org Name:KENNEDY BROTHERS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-372-6317
Mailing Address - Street 1:15 OAK ST
Mailing Address - Street 2:STE 1
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492
Mailing Address - Country:US
Mailing Address - Phone:781-444-1614
Mailing Address - Fax:781-444-9260
Practice Address - Street 1:15 OAK ST
Practice Address - Street 2:STE 1
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492
Practice Address - Country:US
Practice Address - Phone:781-444-1614
Practice Address - Fax:781-444-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA88225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY61363OtherBCBS
MAY61363OtherBCBS