Individual
KEVIN PENNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
55 WARREN AVE, PORTLAND, ME 04103-1103
(207) 577-1010
Mailing address
95 BOOTHBY AVE, SOUTH PORTLAND, ME 04106-4628
(207) 577-1010
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT4495
ME
Other
Enumeration date
04/23/2014
Last updated
04/23/2014
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