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General NPI Number Information
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NPI Number | 1063697787
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Entity Type | Individual
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Provider Name | KENNETH JOHN READER LMT
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Gender | Male
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 02/15/2021
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Provider Practice Location Address
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Address Line | 6440 E BROADWAY BLVD
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City | TUCSON
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State | AZ
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Zip | 85710-3504
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Country | US
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Telephone | 520-881-0877
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Fax |
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Provider Business Mailing Address
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Address Line | 8401 S KOLB RD UNIT 285
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City | TUCSON
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State | AZ
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Zip | 85756-9620
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Country | US
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Telephone | 503-317-1694
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 10773
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 22514
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License Number State | AZ
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