MEDICARE: KENNETH ANDRII ERVIN-BECKFORD

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	MT-27586	AZ

General Provider Information

NPI Number	:	1447097621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH ANDRII ERVIN-BECKFORD

Provider Business Mailing Address
First Line	:	45 CASTLE ROCK RD STE 2A
Second Line	:
City	:	SEDONA
State	:	AZ
Zip	:	86351-8806
Country	:	US
Telephone Number	:	928-592-3506
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 CASTLE ROCK RD STE 2A
Second Line	:
City	:	SEDONA
State	:	AZ
Zip	:	86351-8806
Country	:	US
Telephone Number	:	928-592-3506
Fax Number	:

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

Provider Enumeration Date	:	07/13/2024
Last Update Date	:	07/13/2024

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Directions to “ KENNETH ANDRII ERVIN-BECKFORD ” Practice Location

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