Provider Demographics
NPI:1871791822
Name:KENEALLY PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:KENEALLY PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:KENEALLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:781-883-0190
Mailing Address - Street 1:47 HINES RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-6105
Mailing Address - Country:US
Mailing Address - Phone:781-883-0190
Mailing Address - Fax:508-435-8183
Practice Address - Street 1:77 W MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-1684
Practice Address - Country:US
Practice Address - Phone:781-883-0190
Practice Address - Fax:508-435-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0398314Medicaid