MEDICARE: ANTHONY T KENNON PT

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	PTH1955	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB9027	OTHER	AL	RAILROAD MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1003819608	OTHER	AL	GROUP NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912920133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY T KENNON PT

Provider Business Mailing Address
First Line	:	1908 FLINT RD SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-6031
Country	:	US
Telephone Number	:	256-340-9708
Fax Number	:	256-340-9624

Provider Business Practice Location Address
First Line	:	4223 ORANGE BEACH BLVD
Second Line	:	SUITE D
City	:	ORANGE BEACH
State	:	AL
Zip	:	36561-3459
Country	:	US
Telephone Number	:	251-981-1300
Fax Number	:	251-981-1305

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	03/27/2009

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Directions to “ ANTHONY T KENNON PT” Practice Location

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