Healthcare Provider Details

I. General information

NPI: 1770445165
Provider Name (Legal Business Name): KENNEDY HARDEMION PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 W 213TH ST
TORRANCE CA
90501-2800
US

IV. Provider business mailing address

712 W BEACH AVE APT 4
INGLEWOOD CA
90302-2045
US

V. Phone/Fax

Practice location:
  • Phone: 310-328-0276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number309071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: