Provider Demographics
NPI:1740999028
Name:BINGLEY, KENDAL (PTA)
Entity type:Individual
Prefix:
First Name:KENDAL
Middle Name:
Last Name:BINGLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KENDAL
Other - Middle Name:
Other - Last Name:STINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:311 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-3842
Mailing Address - Country:US
Mailing Address - Phone:501-912-2224
Mailing Address - Fax:
Practice Address - Street 1:311 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-3842
Practice Address - Country:US
Practice Address - Phone:501-912-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3569225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant