Provider Demographics
NPI:1720726870
Name:JENDRAL, KATHERINE (LMT, CLT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:JENDRAL
Suffix:
Gender:F
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2154
Mailing Address - Country:US
Mailing Address - Phone:570-726-1770
Mailing Address - Fax:
Practice Address - Street 1:103 N 7TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2154
Practice Address - Country:US
Practice Address - Phone:570-726-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01320600225700000X
PAMSG012568225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist