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General NPI Number Information
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NPI Number | 1760028732
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Entity Type | Individual
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Provider Name | VANESSA MARIE KENNEDY DPT
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Gender | Female
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 1731 BUNKER HILL RD NE
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City | WASHINGTON
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State | DC
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Zip | 20017-3026
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Country | US
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Telephone | 202-635-5756
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Fax |
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Provider Business Mailing Address
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Address Line | 3115 BUDD WAY
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City | ALEXANDRIA
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State | VA
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Zip | 22310-2205
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Country | US
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Telephone | 508-633-2595
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT871332
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License Number State | DC
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