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General NPI Number Information
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NPI Number | 1578221172
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Entity Type | Individual
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Provider Name | DANIELLE TORI KENNEDY PTA
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Gender | Female
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 1687 CENTER POINT PKWY STE 101
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City | BIRMINGHAM
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State | AL
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Zip | 35215-5525
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Country | US
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Telephone | 205-730-5005
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Fax |
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Provider Business Mailing Address
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Address Line | 251 JOHNSTON ST SE STE 200
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City | DECATUR
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State | AL
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Zip | 35601-2515
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Country | US
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Telephone | 256-350-1764
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTH7782
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License Number State | AL
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