Provider Demographics
NPI:1881220689
Name:FUNK, KENDRA (PTA)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:FUNK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 CRENSHAW RD STE D100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3095
Mailing Address - Country:US
Mailing Address - Phone:713-943-1100
Mailing Address - Fax:
Practice Address - Street 1:5150 CRENSHAW RD STE D100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3095
Practice Address - Country:US
Practice Address - Phone:713-943-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2105867225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant