Provider Demographics
NPI:1386797207
Name:KENNALLY, MICHAEL THOMAS (DPT)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:KENNALLY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28 QUASONS PATH
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-2690
Mailing Address - Country:US
Mailing Address - Phone:774-323-0128
Mailing Address - Fax:
Practice Address - Street 1:390 ORLEANS RD
Practice Address - Street 2:
Practice Address - City:NORTH CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02650-1154
Practice Address - Country:US
Practice Address - Phone:508-945-9611
Practice Address - Fax:508-945-9603
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist