Provider Demographics
NPI:1104709609
Name:KANAVEL, CHEYANN MARIE (LMT)
Entity type:Individual
Prefix:
First Name:CHEYANN
Middle Name:MARIE
Last Name:KANAVEL
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 1:210 W CONTINENTAL RD STE 130A
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85622-3546
Mailing Address - Country:US
Mailing Address - Phone:520-906-8358
Mailing Address - Fax:
Practice Address - Street 1:210 W CONTINENTAL RD STE 130A
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85622-3546
Practice Address - Country:US
Practice Address - Phone:520-906-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-14093225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty