Provider Demographics
NPI:1740996826
Name:WOLVERTON, KENDALL (PT)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:WOLVERTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 CHARRICE PL
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6416
Mailing Address - Country:US
Mailing Address - Phone:850-228-1698
Mailing Address - Fax:
Practice Address - Street 1:693 CHARRICE PL
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-6416
Practice Address - Country:US
Practice Address - Phone:850-228-1698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist