Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | BP10062861 | TX |
NPI | 1003312349 |
---|---|
Provider Name | Kendall Hulk |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 04/04/2018 |