Provider Demographics
NPI:1205126026
Name:MCCORMICK, KENDRA ANN (RPT)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:ANN
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23415 FRUIT TREE DR
Mailing Address - Street 2:
Mailing Address - City:SMITHSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21783-1443
Mailing Address - Country:US
Mailing Address - Phone:301-824-6159
Mailing Address - Fax:
Practice Address - Street 1:1175 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5906
Practice Address - Country:US
Practice Address - Phone:301-733-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist