Provider Demographics
NPI:1306404207
Name:MILLER, KENDALL ROSE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:ROSE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:NICOLE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6913 JESSICA CT
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-3667
Mailing Address - Country:US
Mailing Address - Phone:214-458-3588
Mailing Address - Fax:469-532-0740
Practice Address - Street 1:6913 JESSICA CT
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-3667
Practice Address - Country:US
Practice Address - Phone:214-458-3588
Practice Address - Fax:469-532-0740
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1318488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1318488OtherPHYSICAL THERAPIST LICENSE NUMBER