Provider Demographics
NPI:1184170342
Name:KINDER, TERRA (PT, DPT)
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:KINDER
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 1:2 TUFF ST
Mailing Address - Street 2:
Mailing Address - City:ASH FLAT
Mailing Address - State:AR
Mailing Address - Zip Code:72513-9755
Mailing Address - Country:US
Mailing Address - Phone:870-994-7778
Mailing Address - Fax:870-994-2531
Practice Address - Street 1:2 TUFF ST
Practice Address - Street 2:
Practice Address - City:ASH FLAT
Practice Address - State:AR
Practice Address - Zip Code:72513-9755
Practice Address - Country:US
Practice Address - Phone:870-994-7778
Practice Address - Fax:870-994-2531
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist