Healthcare Provider Details

I. General information

NPI: 1497689012
Provider Name (Legal Business Name): RACHEL KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 N MARTIN LUTHER KING JR BLVD
TULSA OK
74106-6450
US

IV. Provider business mailing address

1383 E 45TH PL
TULSA OK
74105-4107
US

V. Phone/Fax

Practice location:
  • Phone: 918-425-3583
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3093
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: