MEDICARE: MRS. TAMARA J KENNEDY PT

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	174400000X	Specialist	2305204444	VA
2	174400000X	Specialist	PT24126	FL

General Provider Information

NPI Number	:	1447290101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMARA J KENNEDY PT

Provider Business Mailing Address
First Line	:	4415 W WATROUS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-4229
Country	:	US
Telephone Number	:	813-288-8438
Fax Number	:

Provider Business Practice Location Address
First Line	:	6613 49TH ST
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-5728
Country	:	US
Telephone Number	:	727-527-2100
Fax Number	:	727-521-3710

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	09/29/2008

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