Provider Demographics
NPI:1538206370
Name:KENNEDY, DANA LYNNE (RPT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LYNNE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 LEDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:NH
Mailing Address - Zip Code:03222-7301
Mailing Address - Country:US
Mailing Address - Phone:603-744-5315
Mailing Address - Fax:
Practice Address - Street 1:908 HANOVER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-5422
Practice Address - Country:US
Practice Address - Phone:603-641-6603
Practice Address - Fax:603-644-3001
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNH2178Medicare ID - Type Unspecified