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General NPI Number Information
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NPI Number | 1528606118
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Entity Type | Organization
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Legal Business Name | KENEALLY PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 12/15/2019
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Last Update Date | 12/15/2019
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Provider Practice Location Address
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Address Line | 14127 CAPRI DR STE 5A
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City | LOS GATOS
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State | CA
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Zip | 95032-1534
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Country | US
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Telephone | 781-883-0190
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Fax |
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Provider Business Mailing Address
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Address Line | 1153 STAFFORD DR
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City | CUPERTINO
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State | CA
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Zip | 95014-4968
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Country | US
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Telephone | 781-883-0190
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PT
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Name | ALLISON KENEALLY
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Credential | PT
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Telephone | 781-883-0190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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