MEDICARE: KENDRA M CARTER MPT

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
1	225100000X	Physical Therapist	PT10451	OH
2	2251P0200X	Pediatric Physical Therapist	PT10451	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457443087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA M CARTER MPT

Provider Business Mailing Address
First Line	:	5817 W BREEZEWAY DR
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-5147
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5490 MILLS CREEK LN
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-2339
Country	:	US
Telephone Number	:	440-353-1136
Fax Number	:	440-327-4410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	03/21/2014

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