Provider Demographics
NPI:1568008696
Name:KENDRICK, JEREKIA VERONICA
Entity Type:Individual
Prefix:
First Name:JEREKIA
Middle Name:VERONICA
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14613 SHIELDS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BELLE HAVEN
Mailing Address - State:VA
Mailing Address - Zip Code:23306-1512
Mailing Address - Country:US
Mailing Address - Phone:757-303-4819
Mailing Address - Fax:
Practice Address - Street 1:516 GREAT BRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-7034
Practice Address - Country:US
Practice Address - Phone:757-447-0511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603686225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant