Kelly Jean Kennedy, PTA
Individual provider Active NPI Physical Therapy Assistant · Whitehouse, TX
NPI 1093967903 · NPPES record last updated Oct 22, 2008
Key facts
- NPI
- 1093967903
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 2041242 (TX)
- Practice address
- 1221 Corey Dr
Whitehouse, TX 75791-3731 - Phone
- (903) 839-1266
- NPI assigned
- Oct 22, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2041242 | TX | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2041242 | TX | Yes |
Addresses
Primary practice location
1221 Corey Dr
Whitehouse, TX 75791-3731
Mailing address
1221 Corey Dr
Whitehouse, TX 75791-3731
Phone (903) 839-1266
Other providers in Whitehouse, TX
- Janet Hurley
- Abigail Johnson
- Anna Marie Johnson
- Angela Marie Jordan Blount
- Amanda M Kelly
- James Michael Kitchens
- Paula Kitchens
- Terri S. Krause
- Maurice Laperriere
- Cheryl D Layne
All providers in Whitehouse, TX · Physical Therapy Assistant in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.