Provider Demographics
NPI:1316340243
Name:KENNY, BEATRICE MARGARET (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MISS
First Name:BEATRICE
Middle Name:MARGARET
Last Name:KENNY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MISS
Other - First Name:BECKY
Other - Middle Name:MARGARET
Other - Last Name:KENNY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:PO BOX 761
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-0761
Mailing Address - Country:US
Mailing Address - Phone:208-416-1802
Mailing Address - Fax:
Practice Address - Street 1:1875 N LAKEWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4928
Practice Address - Country:US
Practice Address - Phone:208-667-3583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMASG-83225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist