Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1265450977 |
---|---|
Provider Name | Ms. Rebecca Jean Kennedy |
First Address | Portland, OR 97217-3338 |
Second Address | Portland, OR 97217-3338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |