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NPI Code Detail

MEDICARE: QUINN KENNEDY RODERICK DPT

MEDICARE: QUINN KENNEDY RODERICK 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 Therapist034206AZ
2225100000XPhysical TherapistCP051259TNC

General Provider Information

NPI Number : 1417673120
Entity Type Code : Individual
Provider Name (Legal Business Name) : QUINN KENNEDY RODERICK DPT
Provider Business Mailing Address
First Line : 801 BRIAR GATE DR
Second Line :
City : HOLLY SPRINGS
State : NC
Zip : 27540-5802
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 113 HILLCREST DR
Second Line :
City : SANFORD
State : NC
Zip : 27330-4020
Country : US
Telephone Number : 919-777-0240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2022
Last Update Date : 03/04/2026

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