Provider Demographics
NPI:1528142585
Name:KENNEDY, GEORGE E (PT)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:E
Last Name:KENNEDY
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 1:6334 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3133
Mailing Address - Country:US
Mailing Address - Phone:219-980-2728
Mailing Address - Fax:219-980-2728
Practice Address - Street 1:6334 HAYES ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3133
Practice Address - Country:US
Practice Address - Phone:219-980-2728
Practice Address - Fax:219-980-2728
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05000857A225100000X
IA00613225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist