Healthcare Provider Details

I. General information

NPI: 1407257496
Provider Name (Legal Business Name): MAUREEN KENNEDY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 03/29/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6354 JACKSON ST
PITTSBURGH PA
15206-2232
US

IV. Provider business mailing address

ATAMMC 9300 DEWITT LOOP
FT BELVOIR VA
22060
US

V. Phone/Fax

Practice location:
  • Phone: 443-223-7501
  • Fax:
Mailing address:
  • Phone: 571-231-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305208860
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: