Healthcare Provider Details

I. General information

NPI: 1972116481
Provider Name (Legal Business Name): KENDRA KAY ROMIG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 BROOKWOOD DR
LITTLE ROCK AR
72202
US

IV. Provider business mailing address

3920 WOODLAND HEIGHTS RD
LITTLE ROCK AR
72212-2495
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-6965
  • Fax: 501-227-3606
Mailing address:
  • Phone: 501-227-3674
  • Fax: 501-227-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4843
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: