Doctor Name: | STACY ANN KENNELLY |
NPI Number: | 1528261989 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA PT |
License Number: | 5371 |
Business Practice Address: | 1612 N 37th Street Superior, WI - 54880 |
Business Phone Number: | 7153925144 |
Business Fax Number: | |
Mailing Address: | 2877 Northern Drive, SUPERIOR |
State: | WI |
Postal Code: | 54880 |
Phone Number: | 7153924965 |
Fax Number: | |
NPI Enumeration Date: | 06/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 5371 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MN |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |