Provider Demographics
NPI:1891509170
Name:CANTON, KENDRA LYNN (LMT C-MLD)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:LYNN
Last Name:CANTON
Suffix:
Gender:F
Credentials:LMT C-MLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PLAID PL
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3622
Mailing Address - Country:US
Mailing Address - Phone:518-630-7467
Mailing Address - Fax:
Practice Address - Street 1:22 PLAID PL
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3622
Practice Address - Country:US
Practice Address - Phone:518-630-7467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032084225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist