Healthcare Provider Details

I. General information

NPI: 1265869341
Provider Name (Legal Business Name): BRAD ALLEN KENNEDY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 OSAGE ST
SIDNEY NE
69162-1714
US

IV. Provider business mailing address

118 VIRGINIA LN
SIDNEY NE
69162-2626
US

V. Phone/Fax

Practice location:
  • Phone: 308-254-5355
  • Fax:
Mailing address:
  • Phone: 308-254-6222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1839
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: