Provider Demographics
NPI:1639373632
Name:EDWARDS, KENDARA ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:KENDARA
Middle Name:ELIZABETH
Last Name:EDWARDS
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 1:7625 PARAGON RD
Mailing Address - Street 2:STE A
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4063
Mailing Address - Country:US
Mailing Address - Phone:937-424-5607
Mailing Address - Fax:937-425-0032
Practice Address - Street 1:7625 PARAGON RD
Practice Address - Street 2:STE A
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4063
Practice Address - Country:US
Practice Address - Phone:937-424-5607
Practice Address - Fax:937-425-0032
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-011001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist