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General NPI Number Information
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NPI Number | 1568423549
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Entity Type | Individual
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Provider Name | VANNETA K KENNEDY PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 01/09/2013
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Provider Practice Location Address
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Address Line | 10640 CHARTER HILL CT SUITE 102
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City | ASHLAND
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State | VA
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Zip | 23005-7749
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Country | US
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Telephone | 804-550-5730
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Fax | 804-550-5733
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Provider Business Mailing Address
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Address Line | 771 PILOT HOUSE DR
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City | NEWPORT NEWS
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State | VA
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Zip | 23606
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Country | US
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Telephone | 757-873-2302
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Fax | 757-873-2306
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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 | 2305204413
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License Number State | VA
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