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General NPI Number Information
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NPI Number | 1629894472
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Entity Type | Individual
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Provider Name | KENNEDI RILEY
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Gender | Female
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 8511 LIBERTY RD STE BB
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-4837
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Country | US
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Telephone | 443-426-9100
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Fax | 410-922-0679
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 410-933-0000
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 30198
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License Number State | MD
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