Provider Demographics
NPI:1457304933
Name:SPRACKLIN, KENDALL BURT (PT)
Entity Type:Individual
Prefix:MR
First Name:KENDALL
Middle Name:BURT
Last Name:SPRACKLIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:191 HAY MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:N ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1443
Mailing Address - Country:US
Mailing Address - Phone:978-688-2219
Mailing Address - Fax:
Practice Address - Street 1:575 TURNPIKE ST
Practice Address - Street 2:SUITE 14
Practice Address - City:N ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5924
Practice Address - Country:US
Practice Address - Phone:978-686-9688
Practice Address - Fax:978-688-2163
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASPY65040Medicare ID - Type Unspecified