Provider Demographics
NPI:1184472219
Name:KINDRED, NICOLE ROSE (DPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ROSE
Last Name:KINDRED
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25641 FAWN FOREST RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-6308
Mailing Address - Country:US
Mailing Address - Phone:832-721-7540
Mailing Address - Fax:
Practice Address - Street 1:26865 INTERSTATE 45 STE 300
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-4046
Practice Address - Country:US
Practice Address - Phone:281-292-4800
Practice Address - Fax:281-292-9588
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1392009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist