Provider Demographics
NPI:1194129965
Name:KENNEDY, BAILEE (DPT)
Entity type:Individual
Prefix:
First Name:BAILEE
Middle Name:
Last Name:KENNEDY
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 1:151 CORNEL LN
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-7230
Mailing Address - Country:US
Mailing Address - Phone:423-202-4681
Mailing Address - Fax:
Practice Address - Street 1:9020 SENCA DR STE 220
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-6680
Practice Address - Country:US
Practice Address - Phone:910-264-9317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7166225100000X
NCP19137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist