Provider Demographics
NPI:1427668920
Name:GRUENDELL, KENDELL (LMT)
Entity type:Individual
Prefix:MRS
First Name:KENDELL
Middle Name:
Last Name:GRUENDELL
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 1:690 HERMOSA PALMS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2314
Mailing Address - Country:US
Mailing Address - Phone:702-972-3633
Mailing Address - Fax:
Practice Address - Street 1:690 HERMOSA PALMS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2314
Practice Address - Country:US
Practice Address - Phone:702-972-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.5246225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist