Provider Demographics
NPI:1902059991
Name:SAVAGE, KENT DWAIN (LMT)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:DWAIN
Last Name:SAVAGE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LOUISIANA
Mailing Address - Street 2:STE. 402
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404
Mailing Address - Country:US
Mailing Address - Phone:361-774-3894
Mailing Address - Fax:361-853-0489
Practice Address - Street 1:1001 LOUISIANA
Practice Address - Street 2:STE. 402
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404
Practice Address - Country:US
Practice Address - Phone:361-774-3894
Practice Address - Fax:361-853-0489
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT000128225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist