Provider Demographics
NPI:1922313931
Name:KENDRICK, ANGEL K (PT ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:K
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:PT ASSISTANT
Other - Prefix:MS
Other - First Name:ANGEL
Other - Middle Name:K
Other - Last Name:GASSMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:132 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06412-1340
Mailing Address - Country:US
Mailing Address - Phone:860-526-5363
Mailing Address - Fax:860-526-1015
Practice Address - Street 1:132 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:CT
Practice Address - Zip Code:06412-1340
Practice Address - Country:US
Practice Address - Phone:860-526-5363
Practice Address - Fax:860-526-1015
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001170225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant