Provider Demographics
NPI:1013313535
Name:KENDALL, LAURA (DPT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:KENDALL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:BOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-8364
Mailing Address - Fax:
Practice Address - Street 1:1600 MILLER TRUNK HWY BLDG C
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-5640
Practice Address - Country:US
Practice Address - Phone:218-786-5360
Practice Address - Fax:701-222-3186
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1817225100000X
MN9855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1469164Medicaid