MEDICARE: PATRICIA KILKENNY RPT

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
1	225100000X	Physical Therapist	1100984	KS

General Provider Information

NPI Number	:	1154326114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA KILKENNY RPT

Provider Business Mailing Address
First Line	:	1305 WAKARUSA DR
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-3830
Country	:	US
Telephone Number	:	785-842-3444
Fax Number	:	785-842-3410

Provider Business Practice Location Address
First Line	:	930 AMES ST
Second Line	:
City	:	BALDWIN CITY
State	:	KS
Zip	:	66006-8232
Country	:	US
Telephone Number	:	785-594-2600
Fax Number	:	785-594-2600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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