Healthcare Provider Details

I. General information

NPI: 1487442935
Provider Name (Legal Business Name): MARY JOE RAY KINNEY LMT, NHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 25
BURT MI
48417-0025
US

IV. Provider business mailing address

PO BOX 25
BURT MI
48417-0025
US

V. Phone/Fax

Practice location:
  • Phone: 989-860-4726
  • Fax:
Mailing address:
  • Phone: 989-860-4726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501015512
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: