Provider Demographics
NPI:1598072845
Name:NELSON, KENDRA CORDERO (DPT)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:CORDERO
Last Name:NELSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:KENDRA
Other - Middle Name:LOUISE
Other - Last Name:CORDERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:370 RIVER ROAD
Mailing Address - Street 2:UNIVERSITY HEALTH CENTER PHYSICAL THERAPY DEPARTMENT
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602
Mailing Address - Country:US
Mailing Address - Phone:706-542-8634
Mailing Address - Fax:706-583-0217
Practice Address - Street 1:370 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602
Practice Address - Country:US
Practice Address - Phone:706-542-8634
Practice Address - Fax:706-583-0217
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37041225100000X
GAPT010301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist