Provider Demographics
NPI:1013260298
Name:REID, KENDRA (PT)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5751 W DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46072-8686
Mailing Address - Country:US
Mailing Address - Phone:619-507-2166
Mailing Address - Fax:
Practice Address - Street 1:2900 CHARLEVOIX DR SE STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7086
Practice Address - Country:US
Practice Address - Phone:616-975-5081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010604A225100000X
CAPT18595225100000X
MN9227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist