Provider Demographics
NPI:1336532639
Name:STANALAND, KENDRA (PT)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:STANALAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3738 E 82ND CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-1603
Mailing Address - Country:US
Mailing Address - Phone:918-851-4294
Mailing Address - Fax:
Practice Address - Street 1:1165 BRENNER RD
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-6141
Practice Address - Country:US
Practice Address - Phone:918-224-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40192251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics