Provider Demographics
NPI:1316216419
Name:PIETILA, KENDRA (PTA)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:
Last Name:PIETILA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:PIETILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:96 CROIX ST
Mailing Address - Street 2:APARTMENT 5
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-1157
Mailing Address - Country:US
Mailing Address - Phone:906-235-1764
Mailing Address - Fax:
Practice Address - Street 1:435 STONEVILLE RD
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-2921
Practice Address - Country:US
Practice Address - Phone:906-485-1073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant