Basic Information
| Provider Information | |||||||||
| NPI: | 1568423549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KENNEDY | ||||||||
| FirstName: | VANNETA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 771 PILOT HOUSE DR | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578732302 | ||||||||
| FaxNumber: | 7578732306 | ||||||||
| Practice Location | |||||||||
| Address1: | 10640 CHARTER HILL CT | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ASHLAND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230057749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045505730 | ||||||||
| FaxNumber: | 8045505733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 01/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305204413 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | P00245786 | 01 | VA | RAILROAD MEDICARE | OTHER | 010192153 | 05 | VA | MEDICAID | 192931 | 01 | VA | BCBS PHYSICAL THERAPY | OTHER | 7867723 | 01 | AETNA | OTHER |