Provider Demographics
NPI:1891055059
Name:KENDRICK, KRISTOFER M (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:KRISTOFER
Middle Name:M
Last Name:KENDRICK
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 YORKSHIRE MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1886
Mailing Address - Country:US
Mailing Address - Phone:859-263-5140
Mailing Address - Fax:859-263-5141
Practice Address - Street 1:3401 YORKSHIRE MEDICAL PARK # PSC
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2513
Practice Address - Country:US
Practice Address - Phone:859-263-5140
Practice Address - Fax:859-263-5141
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY006434OtherKENTUCKY BOARD OF PT
VA0126001782OtherATC LICENSE
VA0126001782OtherATC LICENSE