Provider Demographics
NPI:1205885233
Name:STROUSE, KENDRA GAIL (PT)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:GAIL
Last Name:STROUSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:GAIL
Other - Last Name:MCCORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:860 JAMACHA RD STE 203
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3224
Mailing Address - Country:US
Mailing Address - Phone:619-573-6373
Mailing Address - Fax:619-378-6578
Practice Address - Street 1:891 KUHN DR
Practice Address - Street 2:#117
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3551
Practice Address - Country:US
Practice Address - Phone:619-656-5176
Practice Address - Fax:619-656-5173
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 22950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT22950BMedicare PIN