Basic Information
| Provider Information | |||||||||
| NPI: | 1710113451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENNEDY | ||||||||
| FirstName: | JUNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ST. ROMAIN | ||||||||
| OtherFirstName: | JUNE | ||||||||
| OtherMiddleName: | E | ||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1108 DRESSER CT | ||||||||
| Address2: | SUINTE 201B | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198768302 | ||||||||
| FaxNumber: | 9199548706 | ||||||||
| Practice Location | |||||||||
| Address1: | 1108 DRESSER CT | ||||||||
| Address2: | SUINTE 201B | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198768302 | ||||||||
| FaxNumber: | 9199548706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2009 | ||||||||
| LastUpdateDate: | 06/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3484 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.