=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427908664
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEE KENNEDY LMBT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2026
-----------------------------------------------------
Last Update Date | 01/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 BATTLEGROUND AVE STE 150G
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27408-8030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-681-0109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7057 W FRIENDLY AVE UNIT R
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27410-6324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-681-1019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 17922
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------