Provider Demographics
NPI:1225292691
Name:ANOE, KENNEDY EDWARD (LMT)
Entity Type:Individual
Prefix:MR
First Name:KENNEDY
Middle Name:EDWARD
Last Name:ANOE
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 1:9500 SW BARBUR BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5466
Mailing Address - Country:US
Mailing Address - Phone:503-781-8729
Mailing Address - Fax:
Practice Address - Street 1:9500 SW BARBUR BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5466
Practice Address - Country:US
Practice Address - Phone:503-781-8729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14012172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist