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Individual

JEREMY KENNEDY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
5413 SE WASHINGTON STREET, PORTLAND, OR 97215
(985) 630-7912
Mailing address
5423 SE WASHINGTON STREET, PORTLAND, OR 97215

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
06629
OR

Other

Enumeration date
11/22/2013
Last updated
11/22/2013
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