Provider Demographics
NPI:1306800875
Name:KENNEY, MICHAEL P (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:KENNEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-5091
Mailing Address - Country:US
Mailing Address - Phone:617-972-5288
Mailing Address - Fax:617-972-5345
Practice Address - Street 1:485 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-5091
Practice Address - Country:US
Practice Address - Phone:617-972-5288
Practice Address - Fax:617-972-5345
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA908025OtherTUFTS HEALTH PLAN
MAY68453OtherBLUE CROSS
MA0035679OtherNEIGHBORHOOD HEALTH PLAN
MAHV0001OtherHARVARD PILGRIM
MAB501027OtherCIGNA
MAY69622Medicare ID - Type Unspecified