Provider Demographics
NPI:1902485873
Name:KENNEDY, DYANN RENEE (LMT)
Entity Type:Individual
Prefix:
First Name:DYANN
Middle Name:RENEE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DYANN
Other - Middle Name:R
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:8915 REAMER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2519
Mailing Address - Country:US
Mailing Address - Phone:346-270-0551
Mailing Address - Fax:
Practice Address - Street 1:8915 REAMER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2519
Practice Address - Country:US
Practice Address - Phone:346-270-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT118930225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT118930OtherTDLR