Provider Demographics
NPI:1942827894
Name:DAWSON, KENDRA JENAY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:JENAY
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14650 LANDMARK BLVD APT 1540
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-6935
Mailing Address - Country:US
Mailing Address - Phone:757-572-0183
Mailing Address - Fax:
Practice Address - Street 1:GENESIS PT AND WELLNESS, PLLC
Practice Address - Street 2:4428 MAIN STREET SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226
Practice Address - Country:US
Practice Address - Phone:214-631-9812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1256357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist