MEDICARE: MR. JOEL KENNEDY MPT

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	02787	IA

General Provider Information

NPI Number	:	1326168790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL KENNEDY MPT

Provider Business Mailing Address
First Line	:	4310 ADAMS AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50310-3455
Country	:	US
Telephone Number	:	515-274-4736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1978 GRAND AVE
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-4217
Country	:	US
Telephone Number	:	515-221-2220
Fax Number	:	515-221-2700

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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