Basic Information
| Provider Information | |||||||||
| NPI: | 1538793757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KENNARD | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 557 GREEN MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038828318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814135111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6129 AIRPORT HOTELS BLVD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402133288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029643688 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2020 | ||||||||
| LastUpdateDate: | 02/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.