Provider Demographics
NPI:1316368293
Name:KENT, TY DANNON (LMP)
Entity Type:Individual
Prefix:MR
First Name:TY
Middle Name:DANNON
Last Name:KENT
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10117 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3425
Mailing Address - Country:US
Mailing Address - Phone:425-806-5525
Mailing Address - Fax:425-806-3915
Practice Address - Street 1:10117 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3425
Practice Address - Country:US
Practice Address - Phone:425-806-5525
Practice Address - Fax:425-806-3915
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2014-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60390809225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist