Provider Demographics
NPI:1902351281
Name:KENNEDY, HEATHER (PT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 PRIMERA BLVD.
Mailing Address - Street 2:SUITE 1021
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6050 CATTLERIDGE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6028
Practice Address - Country:US
Practice Address - Phone:941-365-0655
Practice Address - Fax:941-552-7866
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist