Provider Demographics
NPI:1700326964
Name:SMOTHERS, KENDRA (DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:
Last Name:SMOTHERS
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:6842 RACE TRACK RD STE B
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3011
Practice Address - Country:US
Practice Address - Phone:240-544-0200
Practice Address - Fax:301-464-1053
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCBV310074OtherCAREFIRST BCBS
MDBV220074OtherCAREFIRST BCBS