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General NPI Number Information
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NPI Number | 1528071909
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Entity Type | Individual
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Provider Name | AMBER LEE KENNEY MPT, MTC
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Gender | Female
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 100 EXECUTIVE WAY SUITE #109
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City | PONTE VEDRA
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State | FL
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Zip | 32082-2715
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Country | US
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Telephone | 904-543-9011
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Fax | 904-543-1390
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Provider Business Mailing Address
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Address Line | 13019 RIVER SPRINGS WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32224-8506
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Country | US
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Telephone | 904-219-7881
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Fax | 904-543-1390
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 15920
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License Number State | FL
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