Provider Demographics
NPI:1649917485
Name:BUJNOVSKY, KENDRA NOELLE (DPT)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:NOELLE
Last Name:BUJNOVSKY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17729 POWDER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-4629
Mailing Address - Country:US
Mailing Address - Phone:775-846-0061
Mailing Address - Fax:
Practice Address - Street 1:747 FRONTAGE RD
Practice Address - Street 2:UNIT B-200
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602
Practice Address - Country:US
Practice Address - Phone:512-920-6512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1360426225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist