Provider Demographics
NPI:1558660571
Name:HOLMES, KENDYL E (PT)
Entity Type:Individual
Prefix:MS
First Name:KENDYL
Middle Name:E
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 ALVORD PARK RD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3493
Mailing Address - Country:US
Mailing Address - Phone:860-482-8539
Mailing Address - Fax:860-482-0258
Practice Address - Street 1:245 ALVORD PARK RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3493
Practice Address - Country:US
Practice Address - Phone:860-482-8539
Practice Address - Fax:860-482-0258
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2014-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400073754OtherMEDICARE NGS