Provider Demographics
NPI:1780129221
Name:KENDRICK-GRAHAM, SEAN
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:KENDRICK-GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6914 MCARDLE RD
Mailing Address - Street 2:APT. 91
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4156
Mailing Address - Country:US
Mailing Address - Phone:361-500-7458
Mailing Address - Fax:
Practice Address - Street 1:6914 MCARDLE RD
Practice Address - Street 2:APT. 91
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4156
Practice Address - Country:US
Practice Address - Phone:361-500-7458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer