Individual
KENNEDY LEWALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
201 PARK PLACE BLVD, KISSIMMEE, FL 34741-2345
(407) 530-5063
Mailing address
601 SEQUOYAH LN, ALTUS, OK 73521-1753
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3279
OK
Other
Enumeration date
02/23/2023
Last updated
02/23/2023
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