Provider Demographics
NPI:1104077403
Name:KENNEDY, MAGEN T (MPT)
Entity type:Individual
Prefix:MRS
First Name:MAGEN
Middle Name:T
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 ROCKLEDGE RD
Mailing Address - Street 2:UNIT GG
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-5305
Mailing Address - Country:US
Mailing Address - Phone:914-202-9201
Mailing Address - Fax:
Practice Address - Street 1:317 NORTH ST
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2209
Practice Address - Country:US
Practice Address - Phone:914-597-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-05
Last Update Date:2008-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026807-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics