Individual
BROOKE ALLISON KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
5625 PEARL DR, EVANSVILLE, IN 47712-8106
(812) 759-7493
(812) 401-2346
Mailing address
PO BOX 5629, EVANSVILLE, IN 47716-5629
(812) 476-0409
(812) 476-1016
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
005611
KY
225100000X
Physical Therapist
Primary
05009061A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000485787
BLUE CROSS BLUE SHIELD
IN
01
—
000000674191
ANTHEM BCBS
KY
05
—
200829320
—
IN
01
—
KY005611
KY PT LICENSE
KY
Enumeration date
08/12/2006
Last updated
09/28/2016
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