Individual
JOSEPH A KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTHER
Contact information
Practice address
902 E LINCOLN RD, IDABEL, OK 74745-7337
(580) 286-2600
(580) 286-1107
Mailing address
107 MILES ST, BROKEN BOW, OK 74728-4507
(580) 236-5261
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1117
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1117
PHYSICAL THERAPY
AK
01
—
4463
OKLAHOMA PT LICENSE
OK
Enumeration date
11/08/2006
Last updated
06/07/2011
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