Provider Demographics
NPI:1871804831
Name:KENNEY, DAVID MICHAEL (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:KENNEY
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 BRANDYWINE ST NW STE 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-1876
Mailing Address - Country:US
Mailing Address - Phone:202-905-5640
Mailing Address - Fax:
Practice Address - Street 1:4001 BRANDYWINE ST NW STE 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-1876
Practice Address - Country:US
Practice Address - Phone:202-430-5421
Practice Address - Fax:312-640-1011
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020379225100000X
MD27055225100000X
VA2305213700225100000X
DC872263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC194666YT9Medicare PIN
DCG02816Medicare PIN