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General NPI Number Information
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NPI Number | 1871791822
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Entity Type | Organization
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Legal Business Name | KENEALLY PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 77 W MAIN ST SUITE 205
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City | HOPKINTON
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State | MA
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Zip | 01748-1684
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Country | US
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Telephone | 781-883-0190
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Fax | 508-435-8183
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Provider Business Mailing Address
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Address Line | 47 HINES RD
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City | CUMBERLAND
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State | RI
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Zip | 02864-6105
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Country | US
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Telephone | 781-883-0190
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Fax | 508-435-8183
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ALLISON KENEALLY
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Credential | P.T.
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11473
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License Number State | MA
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