Individual
MR. JUSTIN LEIF KENNERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4650 W SUNSET BLVD, LOS ANGELES, CA 90027-6062
(323) 669-2118
(323) 663-0093
Mailing address
2346 GLENROSE AVE, ALTADENA, CA 91001-5502
(626) 345-1733
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
25910
CA
Other
Enumeration date
03/16/2007
Last updated
07/08/2007
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