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NPI Code Detail

MEDICARE: KENDAHL AIREY LMT

MEDICARE:   KENDAHL  AIREY  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 Therapist101000TX

General Provider Information

NPI Number : 1811441736
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDAHL AIREY LMT
Provider Business Mailing Address
First Line : 3428 ROSEDALE AVE APT D
Second Line :
City : DALLAS
State : TX
Zip : 75205-1569
Country : US
Telephone Number : 972-514-2825
Fax Number :
Provider Business Practice Location Address
First Line : 3428 ROSEDALE AVE APT D
Second Line :
City : DALLAS
State : TX
Zip : 75205-1569
Country : US
Telephone Number : 972-514-2825
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2016
Last Update Date : 08/09/2016

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Directions to “ KENDAHL AIREY LMT” Practice Location

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