Healthcare Provider Details

I. General information

NPI: 1699495739
Provider Name (Legal Business Name): KENNEDY MAROIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 W GLENDALE AVE STE 110
GLENDALE AZ
85307-3005
US

IV. Provider business mailing address

1548 E DRAKE DR
TEMPE AZ
85283-5115
US

V. Phone/Fax

Practice location:
  • Phone: 623-335-3748
  • Fax:
Mailing address:
  • Phone: 402-709-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: