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NPI Code Detail

MEDICARE: DR. ALICIA RENE KENNEDY PT, ATC

MEDICARE: DR. ALICIA RENE KENNEDY PT, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist4142AZ
2225100000XPhysical Therapist17515MA
3225100000XPhysical Therapist015897PA
4225100000XPhysical Therapist4541OR

General Provider Information

NPI Number : 1184770539
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALICIA RENE KENNEDY PT, ATC
Provider Business Mailing Address
First Line : 142 UPPER LAKEVIEW DR
Second Line :
City : HAWLEY
State : PA
Zip : 18428-4025
Country : US
Telephone Number : 516-236-1594
Fax Number :
Provider Business Practice Location Address
First Line : 600 S WYCOMBE AVE
Second Line :
City : YEADON
State : PA
Zip : 19050-2835
Country : US
Telephone Number : 610-626-8065
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2007
Last Update Date : 07/08/2007

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