Provider Demographics
NPI:1588540868
Name:KINNEAR, KADE PETRUS MAKAIO (LMT)
Entity type:Individual
Prefix:
First Name:KADE
Middle Name:PETRUS MAKAIO
Last Name:KINNEAR
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38312 FIVE CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16404-5020
Mailing Address - Country:US
Mailing Address - Phone:814-480-0844
Mailing Address - Fax:
Practice Address - Street 1:2131 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4711
Practice Address - Country:US
Practice Address - Phone:814-480-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG014782225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist