Provider Demographics
NPI:1629454798
Name:FUQUA, KENDRA D (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:D
Last Name:FUQUA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HIGHWAY 62 412 STE A
Mailing Address - Street 2:
Mailing Address - City:ASH FLAT
Mailing Address - State:AR
Mailing Address - Zip Code:72513-9629
Mailing Address - Country:US
Mailing Address - Phone:870-994-7778
Mailing Address - Fax:
Practice Address - Street 1:75 HIGHWAY 62 412 STE A
Practice Address - Street 2:
Practice Address - City:ASH FLAT
Practice Address - State:AR
Practice Address - Zip Code:72513-9629
Practice Address - Country:US
Practice Address - Phone:870-994-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 4012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist