Provider Demographics
NPI:1528071909
Name:KENNEY, AMBER LEE (MPT, MTC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LEE
Last Name:KENNEY
Suffix:
Gender:F
Credentials:MPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13019 RIVER SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-8506
Mailing Address - Country:US
Mailing Address - Phone:904-219-7881
Mailing Address - Fax:904-543-1390
Practice Address - Street 1:100 EXECUTIVE WAY
Practice Address - Street 2:SUITE #109
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-2715
Practice Address - Country:US
Practice Address - Phone:904-543-9011
Practice Address - Fax:904-543-1390
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA175OtherMEDICARE PTAN
FLP00382647OtherMEDICARE RAILROAD
FLP00382647OtherMEDICARE RAILROAD