Provider Demographics
NPI:1801547666
Name:NAGEL, KENDRICH JEREMY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KENDRICH
Middle Name:JEREMY
Last Name:NAGEL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N ARIZONA AVE APT 3020
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1267
Mailing Address - Country:US
Mailing Address - Phone:208-691-2999
Mailing Address - Fax:
Practice Address - Street 1:1828 E FLORENCE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4783
Practice Address - Country:US
Practice Address - Phone:520-510-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist