Provider Demographics
NPI:1851309918
Name:KENWORTHY, SHERRY BELLE (LMT)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:BELLE
Last Name:KENWORTHY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W 1175 N
Mailing Address - Street 2:A44
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-8948
Mailing Address - Country:US
Mailing Address - Phone:435-586-9846
Mailing Address - Fax:
Practice Address - Street 1:236 W 1175 N
Practice Address - Street 2:A44
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-8948
Practice Address - Country:US
Practice Address - Phone:435-463-8501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56960214701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist