Provider Demographics
NPI:1740327808
Name:BRUMLEY, KENDRA (MS PT)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:BRUMLEY
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UNION 433
Mailing Address - Street 2:
Mailing Address - City:SMACKOVER
Mailing Address - State:AR
Mailing Address - Zip Code:71762
Mailing Address - Country:US
Mailing Address - Phone:870-725-0025
Mailing Address - Fax:
Practice Address - Street 1:638 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4604
Practice Address - Country:US
Practice Address - Phone:870-836-1346
Practice Address - Fax:870-836-1446
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157397721Medicaid
AR5Y115OtherBLUE CROSS BLUE SHIELD
ARP00178743OtherMEDICARE RAILROAD
AR157397721Medicaid