Provider Demographics
NPI:1316660160
Name:PIERCY, KENNETH
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:PIERCY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13610 MIDWAY RD STE 248
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4330
Mailing Address - Country:US
Mailing Address - Phone:214-906-2626
Mailing Address - Fax:
Practice Address - Street 1:13610 MIDWAY RD STE 248
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4330
Practice Address - Country:US
Practice Address - Phone:214-906-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012672225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2149062626OtherPHONE