Healthcare Provider Details

I. General information

NPI: 1982282281
Provider Name (Legal Business Name): CAMERON KENNEY PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N MAIN ST
COLLINSVILLE TX
76233-5106
US

IV. Provider business mailing address

1608 N LOCKHART ST
SHERMAN TX
75092-3614
US

V. Phone/Fax

Practice location:
  • Phone: 903-429-6426
  • Fax:
Mailing address:
  • Phone: 903-814-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2153609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: