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NPI Code Detail

MEDICARE: KENDRA WIDNER DPT

MEDICARE: KENDRA WIDNER DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1427471986
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDRA WIDNER DPT
Provider Business Mailing Address
First Line : 1952 E 7000 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-6877
Country : US
Telephone Number : 801-495-5279
Fax Number : 801-495-5303
Provider Business Practice Location Address
First Line : 2611 S DEARBORN ST
Second Line :
City : SEATTLE
State : WA
Zip : 98144-3013
Country : US
Telephone Number : 206-325-6700
Fax Number : 206-325-4088
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2014
Last Update Date : 02/03/2014

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