Active NPI
Kenneth Gene Sebrero Lacandazo, PT
- Physical Medicine & Rehabilitation Physician
- Monteagle, TN
National Provider Identifier
1093335812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 11420
- Practice address
- 26 2ND St
Monteagle, TN 37356-7415 - Phone
- (932) 924-2041
- NPI assigned
- Apr 22, 2020
- Last updated
- Apr 22, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 11420 | TN | Primary |
Addresses
Primary practice location
26 2ND St
Monteagle, TN 37356-7415
Mailing address
26 2ND St
Monteagle, TN 37356-7415
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 137911973 | Other | TN | DRIVER'S LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11420 | TN | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587513600000",
"number": "1093335812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 2ND ST",
"city": "MONTEAGLE",
"state": "TN",
"postal_code": "373567415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 2ND ST",
"city": "MONTEAGLE",
"state": "TN",
"postal_code": "373567415",
"telephone_number": "932-924-2041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACANDAZO",
"first_name": "KENNETH GENE",
"middle_name": "SEBRERO",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-04-22",
"last_updated": "2020-04-22",
"certification_date": "2020-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "TN",
"license": "11420",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVER'S LICENSE",
"identifier": "137911973",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monteagle, TN
- Janet Denise Harlow, LPE
- Hugh Edwin Hodges, D.V.M.
- HQM of Monteagle, LLC (The Bridge at Monteagle)
- Clifford Louis Huffman Jr., FNP-BC
- William Carl Kerstetter, LPC/MHSP
- LP Monteagle LLC (Signature HealthCARE of Monteagle Rehab & Wellness Center)
- Kenneth D Malhoit, DDS
- Rita Milner, APRN,BC
- Monteagle Family Dentistry, PLLC.
- Jennifer Ann Oneal, FNP-BC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.