Basic Information
| Provider Information | |||||||||
| NPI: | 1790232940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KENNEDY | ||||||||
| FirstName: | AMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1397 S LINDEN RD | ||||||||
| Address2: | STE B | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485324194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102309750 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1397 S LINDEN RD | ||||||||
| Address2: | STE B | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485324194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102309750 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2016 | ||||||||
| LastUpdateDate: | 09/06/2016 | ||||||||
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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 | 5501017625 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.