Healthcare Provider Details

I. General information

NPI: 1689089765
Provider Name (Legal Business Name): ZACHARY LEE KENNEDY P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 SOUTHCREST PKWY STE 105
SOUTHAVEN MS
38671-4851
US

IV. Provider business mailing address

6077 E PRIMACY PKWY STE 140
MEMPHIS TN
38119-5754
US

V. Phone/Fax

Practice location:
  • Phone: 901-261-2506
  • Fax: 901-261-2590
Mailing address:
  • Phone: 901-725-8347
  • Fax: 901-259-7637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10012
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: