Provider Demographics
NPI:1588931166
Name:ARMSTRONG, KENNETH J (LMT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:ARMSTRONG
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 1:3685 HARDT RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14057-9639
Mailing Address - Country:US
Mailing Address - Phone:716-906-2087
Mailing Address - Fax:
Practice Address - Street 1:3685 HARDT RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NY
Practice Address - Zip Code:14057-9639
Practice Address - Country:US
Practice Address - Phone:716-906-2087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009452225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist