Provider Demographics
NPI:1447147723
Name:COLLINS, KENNEDY (LMT)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7187A NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRCHILD AIR FORCE BASE
Mailing Address - State:WA
Mailing Address - Zip Code:99011-2084
Mailing Address - Country:US
Mailing Address - Phone:606-545-8643
Mailing Address - Fax:
Practice Address - Street 1:3209 E 57TH AVE STE H
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-7040
Practice Address - Country:US
Practice Address - Phone:509-448-9398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61652635225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist