Provider Demographics
NPI:1093944399
Name:KENNEY, CATHERINE M (DPT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:KENNEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:ME
Mailing Address - Zip Code:04489-0006
Mailing Address - Country:US
Mailing Address - Phone:207-992-4000
Mailing Address - Fax:207-558-3285
Practice Address - Street 1:1211 BROADWAY STE 8
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2503
Practice Address - Country:US
Practice Address - Phone:207-992-4000
Practice Address - Fax:207-558-3285
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECA4309Medicaid
ME001200001Medicare PIN