Provider Demographics
NPI:1629409404
Name:KENDALL SPORTS MEDICINE INC.
Entity Type:Organization
Organization Name:KENDALL SPORTS MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLEY
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-274-4242
Mailing Address - Street 1:6701 SUNSET DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4529
Mailing Address - Country:US
Mailing Address - Phone:305-274-4242
Mailing Address - Fax:305-662-5965
Practice Address - Street 1:6701 SUNSET DR
Practice Address - Street 2:SUITE 108
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4529
Practice Address - Country:US
Practice Address - Phone:305-274-4242
Practice Address - Fax:305-662-5965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2374174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty