Provider Demographics
NPI:1699540286
Name:KENNEDY, KIMBERLY ANN (PT, DPT, CLT-LANA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PT, DPT, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E FM 2410 RD STE D
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-6898
Mailing Address - Country:US
Mailing Address - Phone:254-394-2710
Mailing Address - Fax:254-307-9700
Practice Address - Street 1:1200 E FM 2410 RD STE D
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-6898
Practice Address - Country:US
Practice Address - Phone:254-394-2710
Practice Address - Fax:254-307-9700
Is Sole Proprietor?:No
Enumeration Date:2023-11-24
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1373612225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic