Provider Demographics
NPI:1649385428
Name:KENNON, CINDY D (PTA)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:D
Last Name:KENNON
Suffix:
Gender:F
Credentials:PTA
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Mailing Address - Street 1:25 BRIERCROFT OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-3011
Mailing Address - Country:US
Mailing Address - Phone:806-795-7433
Mailing Address - Fax:806-795-7407
Practice Address - Street 1:6014 45TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-3773
Practice Address - Country:US
Practice Address - Phone:806-646-4444
Practice Address - Fax:806-795-7434
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2009-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX2018420225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0133SMedicare PIN