Brent Sheldon Kennedy, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

RPT-1740 Issued in ID

Practice address

3715 Woodking Dr
Idaho Falls, ID 83404-4720

Phone

(208) 529-2255

Fax

(208) 529-2022

NPI assigned

Apr 2, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2002

Medicare assignment

May accept Medicare assignment

Group practices

Foothills Rehabilitation and Performance Services PLLCGroup PAC ID 6406077999, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Foothills Rehabilitation & Performance Services, PLLC

  • Physical Therapist
  • Idaho Falls, ID
  • NPI 1063829836
  Medicare reassignment Care Compare group NPD Authorized official
• Foothills Rehabilitation & Performance Services

  • Physical Therapy Clinic/Center
  • Idaho Falls, ID
  • NPI 1831211093
  NPD Authorized official
• Peak Performance Therapy Services P C

  • Physical Therapist
  • Ammon, ID
  • NPI 1003898974
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409270400000",
    "number": "1295855112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2335 PTARMIGAN WAY",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834015850",
            "telephone_number": "208-552-5661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3715 WOODKING DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834044720",
            "telephone_number": "208-529-2255",
            "fax_number": "208-529-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "BRENT",
        "middle_name": "SHELDON",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2014-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "RPT-1740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806757200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Sue Kelly
• Melissa Ilene Kelly, FNP
• Paulo Kelly, DO
• Trent Merrill Kelly, DDS
• Mark Kelsch, LMSW
• Kenneth E Krell MD PA
• Helen Kenney, P.A.
• Kent Cutforth DDS
• Derek Kent, MD
• Rachel Kent, BS

• Physical Therapist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.