Provider Demographics
NPI:1326622002
Name:THE PATH REHAB & PERFORMANCE LLC
Entity Type:Organization
Organization Name:THE PATH REHAB & PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDERDINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:717-341-2406
Mailing Address - Street 1:252 BROADWAY APT 410
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4000
Mailing Address - Country:US
Mailing Address - Phone:253-693-0161
Mailing Address - Fax:
Practice Address - Street 1:1087 VALENTINE AVE SE
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:WA
Practice Address - Zip Code:98047-2127
Practice Address - Country:US
Practice Address - Phone:253-693-0161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty