MEDICARE: SEAN MICHAEL KENNEDY PT, DPT, SCS, CSCS

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	1291856	TX

General Provider Information

NPI Number	:	1770257800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN MICHAEL KENNEDY PT, DPT, SCS, CSCS

Provider Business Mailing Address
First Line	:	880 ALABAMA ST APT 301
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-5436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 FANNIN ST STE 1620
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1509
Country	:	US
Telephone Number	:	713-704-2200
Fax Number	:

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

Provider Enumeration Date	:	08/03/2021
Last Update Date	:	08/03/2021

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Directions to “ SEAN MICHAEL KENNEDY PT, DPT, SCS, CSCS” Practice Location

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