Provider Demographics
NPI:1326188640
Name:KIRKENDOL, WILLIAM TODD (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:TODD
Last Name:KIRKENDOL
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PICKENS CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-5706
Mailing Address - Country:US
Mailing Address - Phone:731-234-4750
Mailing Address - Fax:
Practice Address - Street 1:3441 RIDGECREST ROAD EXT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-7500
Practice Address - Country:US
Practice Address - Phone:731-988-9071
Practice Address - Fax:731-988-9077
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAT00000005042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer