Provider Demographics
NPI:1407931751
Name:KANNIER, DEAN MASON (PT)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:MASON
Last Name:KANNIER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 BUTTE ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0828
Mailing Address - Country:US
Mailing Address - Phone:530-241-9142
Mailing Address - Fax:530-241-9201
Practice Address - Street 1:951 BUTTE ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0828
Practice Address - Country:US
Practice Address - Phone:530-241-9142
Practice Address - Fax:530-241-9201
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0184300Medicaid
CAPT0184300Medicaid