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NPI Code Detail

MEDICARE: TERRY G KENNEDY PHYSICAL THERAPIST

MEDICARE: TERRY G KENNEDY PHYSICAL THERAPIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1579MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11579OTHERMTSTATE OF MT PHYSICAL THERAPY LICENSE #1579

General Provider Information

NPI Number : 1134377690
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY G KENNEDY PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 1822 W LINCOLN ST STE 1
Second Line :
City : BOZEMAN
State : MT
Zip : 59715-5410
Country : US
Telephone Number : 406-585-4642
Fax Number : 406-585-2878
Provider Business Practice Location Address
First Line : 1822 W LINCOLN ST STE 1
Second Line :
City : BOZEMAN
State : MT
Zip : 59715-5410
Country : US
Telephone Number : 406-585-4642
Fax Number : 406-585-2878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2008
Last Update Date : 09/08/2008

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