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NPI Code Detail

MEDICARE: KENNETH JOHN READER LMT

MEDICARE: KENNETH JOHN READER LMT
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
1225700000XMassage Therapist10773OR
2225700000XMassage Therapist22514AZ

General Provider Information

NPI Number : 1063697787
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH JOHN READER LMT
Provider Business Mailing Address
First Line : 8401 S KOLB RD UNIT 285
Second Line :
City : TUCSON
State : AZ
Zip : 85756-9620
Country : US
Telephone Number : 503-317-1694
Fax Number :
Provider Business Practice Location Address
First Line : 6440 E BROADWAY BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85710-3504
Country : US
Telephone Number : 520-881-0877
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/31/2007
Last Update Date : 02/15/2021

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Directions to “ KENNETH JOHN READER LMT” Practice Location

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