Provider Demographics
NPI:1265605612
Name:STULTS, KENDRA (PT)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:STULTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 PETER ALLEN
Mailing Address - Street 2:
Mailing Address - City:NASH
Mailing Address - State:TX
Mailing Address - Zip Code:75569-3044
Mailing Address - Country:US
Mailing Address - Phone:903-733-4744
Mailing Address - Fax:
Practice Address - Street 1:501 N HERVEY ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-3435
Practice Address - Country:US
Practice Address - Phone:870-777-6798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 2734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist