MEDICARE: COLLEEN KENNEDY

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
1	225100000X	Physical Therapist	40QA00269300	NJ

General Provider Information

NPI Number	:	1679661755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN KENNEDY

Provider Business Mailing Address
First Line	:	163 GEORGE RUSSELL WAY
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07013-2677
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8901 KENNEDY BLVD
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5344
Country	:	US
Telephone Number	:	201-854-6700
Fax Number	:	201-854-6779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	05/15/2008

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Directions to “ COLLEEN KENNEDY ” Practice Location

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