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NPI Code Detail

MEDICARE: GRACE ALEXANDRA KENNEY PT, DPT

MEDICARE: GRACE ALEXANDRA KENNEY PT, 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 TherapistPT014126GA

General Provider Information

NPI Number : 1922654128
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE ALEXANDRA KENNEY PT, DPT
Provider Business Mailing Address
First Line : 6397 LEE HWY STE 300
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-4915
Country : US
Telephone Number : 423-238-7217
Fax Number : 423-238-3473
Provider Business Practice Location Address
First Line : 3790 PLEASANT HILL RD STE 100
Second Line :
City : DULUTH
State : GA
Zip : 30096-5143
Country : US
Telephone Number : 770-497-4228
Fax Number : 770-497-4474
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2019
Last Update Date : 08/13/2019

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