Provider Demographics
NPI:1447540182
Name:KENNEDY, LORI BENDER (LMT, MMP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:BENDER
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15307 STABLE RUN DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-7092
Mailing Address - Country:US
Mailing Address - Phone:281-373-4369
Mailing Address - Fax:281-373-4263
Practice Address - Street 1:15307 STABLE RUN DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-7092
Practice Address - Country:US
Practice Address - Phone:281-373-4369
Practice Address - Fax:281-373-4263
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT107176225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist