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General NPI Number Information
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NPI Number | 1639887136
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Entity Type | Organization
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Legal Business Name | KENEALLY PHYSICAL THERAPY & HOLISTIC HEALING
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 24850 BURNT PINE DR STE 3
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-0905
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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 | 14446 PINE HOLLOW DR
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City | ESTERO
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State | FL
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Zip | 33928-9157
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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 | OWNER/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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