Provider Demographics
NPI:1790152171
Name:MURRAY, KENDALL (PT)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:MURRAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 1ST AVE NE
Mailing Address - Street 2:STE 100
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1568
Mailing Address - Country:US
Mailing Address - Phone:763-682-3005
Mailing Address - Fax:888-250-1730
Practice Address - Street 1:25 1ST AVE NE
Practice Address - Street 2:STE 100
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1568
Practice Address - Country:US
Practice Address - Phone:763-682-3005
Practice Address - Fax:888-250-1730
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist