Provider Demographics
NPI:1831475839
Name:KENDALL, MARIA L (DPT)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:L
Last Name:KENDALL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:L
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1977 DEWAR DR STE J
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5757
Mailing Address - Country:US
Mailing Address - Phone:307-382-3228
Mailing Address - Fax:307-382-6886
Practice Address - Street 1:1977 DEWAR DR STE J
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5757
Practice Address - Country:US
Practice Address - Phone:307-382-3228
Practice Address - Fax:307-382-6886
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1392225100000X
WY2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist