Provider Demographics
NPI:1538549514
Name:KENNEDY, ROBERT FRANKLIN (PTA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRANKLIN
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 MUTUAL DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:WV
Mailing Address - Zip Code:25570-5846
Mailing Address - Country:US
Mailing Address - Phone:304-939-0279
Mailing Address - Fax:
Practice Address - Street 1:6354 US ROUTE 60 E STE 4
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1247
Practice Address - Country:US
Practice Address - Phone:304-733-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001797225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant