Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1009488 | TX |
NPI | 1134413263 |
---|---|
Provider Name | Rubye J Kendrick |
First Address | Tyler, TX 75706-7256 |
Second Address | Tyler, TX 75701-2209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2011 |
Last Update Date | 07/06/2011 |