Provider Demographics
NPI:1083307748
Name:KENNER, CHRISTINA RACHEL (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:RACHEL
Last Name:KENNER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E ALTO RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3674
Mailing Address - Country:US
Mailing Address - Phone:765-457-1405
Mailing Address - Fax:
Practice Address - Street 1:320 E ALTO RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3674
Practice Address - Country:US
Practice Address - Phone:765-457-1405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT22307997225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist