Provider Demographics
NPI:1487442935
Name:KINNEY, MARY JOE RAY (LMT, NHE)
Entity type:Individual
Prefix:
First Name:MARY JOE
Middle Name:RAY
Last Name:KINNEY
Suffix:
Gender:
Credentials:LMT, NHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:BURT
Mailing Address - State:MI
Mailing Address - Zip Code:48417-0025
Mailing Address - Country:US
Mailing Address - Phone:989-860-4726
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 25
Practice Address - Street 2:
Practice Address - City:BURT
Practice Address - State:MI
Practice Address - Zip Code:48417-0025
Practice Address - Country:US
Practice Address - Phone:989-860-4726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
MI7501015512225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No175F00000XOther Service ProvidersNaturopath