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General NPI Number Information
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NPI Number | 1942771969
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Entity Type | Individual
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Provider Name | KENDRICK KENNEDY
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Gender | Male
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 12742 E CALEY AVE
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City | CENTENNIAL
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State | CO
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Zip | 80111-6480
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Country | US
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Telephone | 720-334-1877
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 S YAMPA ST
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City | AURORA
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State | CO
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Zip | 80017-3389
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Country | US
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Telephone | 720-334-1877
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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 | 0021927
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License Number State | CO
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