Provider Demographics
NPI:1578705752
Name:KENNEL, RALF (LMT)
Entity Type:Individual
Prefix:MR
First Name:RALF
Middle Name:
Last Name:KENNEL
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 1:2588 HILLIARD ROME RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7404
Mailing Address - Country:US
Mailing Address - Phone:614-565-1251
Mailing Address - Fax:
Practice Address - Street 1:2588 HILLIARD ROME RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7404
Practice Address - Country:US
Practice Address - Phone:614-565-1251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.015766172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH203877771-00OtherBWC
OH20-3877771-00OtherEIN