Provider Demographics
NPI:1649854159
Name:WILSON, KENDYL CATHERINE (MSCPT)
Entity type:Individual
Prefix:
First Name:KENDYL
Middle Name:CATHERINE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 INVERHURON TRAIL
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:ON
Mailing Address - Zip Code:L6H 5Z7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2303 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2408
Practice Address - Country:US
Practice Address - Phone:209-585-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist