Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1263891 | TX |
NPI | 1053780247 |
---|---|
Provider Name | Olivia Kendall |
First Address | Keller, TX 76244 |
Second Address | Keller, TX 76244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2015 |
Last Update Date | 18/09/2015 |