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NPI Code Detail

MEDICARE: AMY MARLEY - KENNEDY DPT

MEDICARE: AMY MARLEY - KENNEDY DPT
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 Therapist2305214948VA

General Provider Information

NPI Number : 1215059621
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY MARLEY - KENNEDY DPT
Provider Business Mailing Address
First Line : 8930 WAUKEGAN RD
Second Line : SUITE 200
City : MORTON GROVE
State : IL
Zip : 60053-2126
Country : US
Telephone Number : 847-324-3976
Fax Number :
Provider Business Practice Location Address
First Line : 201 BULIFANTS BLVD STE B
Second Line :
City : WILLIAMSBURG
State : VA
Zip : 23188-5731
Country : US
Telephone Number : 757-229-9740
Fax Number : 757-229-9741
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 04/20/2023

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Directions to “ AMY MARLEY - KENNEDY DPT” Practice Location

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