Basic Information
| Provider Information | |||||||||
| NPI: | 1659719102 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KENNY | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2699 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325132699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504754500 | ||||||||
| FaxNumber: | 8502277999 | ||||||||
| Practice Location | |||||||||
| Address1: | 3871 E HIGHWAY 98 | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PORT SAINT JOE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324565301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502277778 | ||||||||
| FaxNumber: | 8502277999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2013 | ||||||||
| LastUpdateDate: | 06/06/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT7194 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.