Provider Demographics
NPI:1497724462
Name:WILLIAMS, KENDRA K (PT)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:K
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:41125 N DAISY MOUNTAIN DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-4954
Mailing Address - Country:US
Mailing Address - Phone:623-551-9706
Mailing Address - Fax:623-551-5078
Practice Address - Street 1:41125 N DAISY MOUNTAIN DR
Practice Address - Street 2:SUITE 121
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-4954
Practice Address - Country:US
Practice Address - Phone:623-551-9706
Practice Address - Fax:623-551-5708
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ61582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ073398Medicaid
AZZ108291Medicare PIN