Provider Demographics
NPI:1245494202
Name:KENNEDY, ALISON ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:ELIZABETH
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 STONEGATE LN
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-7809
Mailing Address - Country:US
Mailing Address - Phone:202-257-5289
Mailing Address - Fax:
Practice Address - Street 1:2238 STONEGATE LN
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-7809
Practice Address - Country:US
Practice Address - Phone:202-257-5289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2506155Medicare UPIN