Healthcare Provider Details

I. General information

NPI: 1124781729
Provider Name (Legal Business Name): KENNEMETRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 HIGHWAY 65 N
CONWAY AR
72032-3506
US

IV. Provider business mailing address

331 S BOLDEN HILL RD
GREENBRIER AR
72058-9024
US

V. Phone/Fax

Practice location:
  • Phone: 501-697-9881
  • Fax: 501-475-1478
Mailing address:
  • Phone: 817-688-5865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN D KENNEMER
Title or Position: OWNER
Credential: OTR, MOT
Phone: 817-688-5865