Provider Demographics
NPI:1538793757
Name:KENNARD, LARRY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:KENNARD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 GREEN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03882-8318
Mailing Address - Country:US
Mailing Address - Phone:781-413-5111
Mailing Address - Fax:
Practice Address - Street 1:6129 AIRPORT HOTELS BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-3288
Practice Address - Country:US
Practice Address - Phone:502-964-3688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty