Healthcare Provider Details

I. General information

NPI: 1871804831
Provider Name (Legal Business Name): DAVID MICHAEL KENNEY PT, DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 BRANDYWINE ST NW STE 101
WASHINGTON DC
20016-1876
US

IV. Provider business mailing address

4001 BRANDYWINE ST NW STE 101
WASHINGTON DC
20016-1876
US

V. Phone/Fax

Practice location:
  • Phone: 202-430-5421
  • Fax: 312-640-1011
Mailing address:
  • Phone: 202-905-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070020379
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27055
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213700
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number872263
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: