MEDICARE: KLAIRE NICOLE KENNEDY PT, DPT

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	2251X0800X	Orthopedic Physical Therapist	1367484	TX

General Provider Information

NPI Number	:	1932922143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KLAIRE NICOLE KENNEDY PT, DPT

Provider Business Mailing Address
First Line	:	25317 HAZY HOLW
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-3602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19787 IH 10 W STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1688
Country	:	US
Telephone Number	:	210-423-3023
Fax Number	:

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

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	11/05/2024

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