Provider Demographics
NPI:1366942419
Name:KENNEY, DANA RAE (MA, ATC)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:RAE
Last Name:KENNEY
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:RAE
Other - Last Name:NEUDORFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, ATC
Mailing Address - Street 1:526 COPPERVALE CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4258
Mailing Address - Country:US
Mailing Address - Phone:818-480-0549
Mailing Address - Fax:
Practice Address - Street 1:526 COPPERVALE CIR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4258
Practice Address - Country:US
Practice Address - Phone:818-480-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer