Provider Demographics
NPI:1952802258
Name:PALACIOS, KENNYA KASSANDRA (PT, DPT, CLT-LANA)
Entity type:Individual
Prefix:DR
First Name:KENNYA
Middle Name:KASSANDRA
Last Name:PALACIOS
Suffix:
Gender:
Credentials:PT, DPT, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 S 111TH DR UNIT 492
Mailing Address - Street 2:
Mailing Address - City:CASHION
Mailing Address - State:AZ
Mailing Address - Zip Code:85329-7031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1216 S 111TH DR UNIT 492
Practice Address - Street 2:
Practice Address - City:CASHION
Practice Address - State:AZ
Practice Address - Zip Code:85329-7031
Practice Address - Country:US
Practice Address - Phone:602-501-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213357225100000X
CAPT2934612251X0800X
AZ31464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic