MEDICARE: DEBORAH DIANE KENDALL PT

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	1104040	TX

General Provider Information

NPI Number	:	1538382338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH DIANE KENDALL PT

Provider Business Mailing Address
First Line	:	2125 AUGUSTA DR APT 24
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3713
Country	:	US
Telephone Number	:	832-772-9623
Fax Number	:

Provider Business Practice Location Address
First Line	:	2125 AUGUSTA DR APT 24
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3713
Country	:	US
Telephone Number	:	832-772-9623
Fax Number	:

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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