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General NPI Number Information
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NPI Number | 1326298985
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Entity Type | Individual
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Provider Name | SARAH MARIE KENNEDY PTA
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Gender | Female
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 6080 SOUTHWEST BLVD
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City | BENBROOK
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State | TX
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Zip | 76109
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Country | US
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Telephone | 817-731-9331
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Fax | 817-731-9882
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Provider Business Mailing Address
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Address Line | 6080 SOUTHWEST BLVD COOPER & BUSH PHYSICAL THERAPY
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City | BENBROOK
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State | TX
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Zip | 76109
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Country | US
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Telephone | 817-731-9331
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Fax | 817-731-9882
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2067489
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License Number State | TX
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