MEDICARE: KENNEDY MALLERY

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
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1699627745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNEDY MALLERY

Provider Business Mailing Address
First Line	:	10866 WASHINGTON BLVD # 143
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-3610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10866 WASHINGTON BLVD # 143
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-3610
Country	:	US
Telephone Number	:	310-571-7951
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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Directions to “ KENNEDY MALLERY ” Practice Location

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