Bradford Jamal Kennebrew, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA003995 Issued in GA

Practice address

1227 Rockbridge Rd Ste 402
Stone Mountain, GA 30087-3006

Phone

(770) 925-9210

NPI assigned

Jul 27, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Independent Physical Therapy of Georgia, LLC

  • Physical Therapist
  • Fort Oglethorpe, GA
  • NPI 1780636068
  NPD (past)
• Independent Physical Therapy, LLC

  • Physical Therapist
  • Stone Mountain, GA
  • NPI 1447654058
  NPD (past)

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

{
    "created_epoch": "1658880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1811623242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 OCEAN AVE",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319076067",
            "telephone_number": "706-325-3988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 ROCKBRIDGE RD STE 402",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873006",
            "telephone_number": "770-925-9210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEBREW",
        "first_name": "BRADFORD",
        "middle_name": "JAMAL",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-27",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA003995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harriet Kay, MSN, PMHNP-BC
• Keep Moving at Home LLC
• Keeping People First Medical
• Ahna Symone Kelley, DDS
• Donna Kristina Kemp, MED, NCC, LPC
• Kenny'S Personal Care Home
• Danielle Kershner, DPT
• Jeanette Kessler, DMD
• Ketara Wellness Center LLC
• Khurram A Khan, M.D.

• Physical Therapy Assistant in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.