Provider Demographics
NPI:1366671620
Name:KIRKENDALL, NICOLE A (DPT, CERT MDT, OCS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:KIRKENDALL
Suffix:
Gender:F
Credentials:DPT, CERT MDT, OCS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:A
Other - Last Name:MOUNDROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44925 MORLEY DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1354
Mailing Address - Country:US
Mailing Address - Phone:586-846-4320
Mailing Address - Fax:586-846-4326
Practice Address - Street 1:44925 MORLEY DR
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-1354
Practice Address - Country:US
Practice Address - Phone:586-846-4320
Practice Address - Fax:586-846-4326
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052073042251X0800X
MI5501018277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic