MEDICARE: LEO HEYDON KENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	7501017496	MI

General Provider Information

NPI Number	:	1174468854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEO HEYDON KENT

Provider Business Mailing Address
First Line	:	26711 WOODWARD AVE STE 305
Second Line	:
City	:	HUNTINGTON WOODS
State	:	MI
Zip	:	48070-1369
Country	:	US
Telephone Number	:	248-631-4728
Fax Number	:

Provider Business Practice Location Address
First Line	:	26711 WOODWARD AVE STE 305
Second Line	:
City	:	HUNTINGTON WOODS
State	:	MI
Zip	:	48070-1369
Country	:	US
Telephone Number	:	248-631-4728
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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