Healthcare Provider Details

I. General information

NPI: 1689943409
Provider Name (Legal Business Name): KENDALL JOAN LABRASH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDALL JOAN WILHELM

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 LAHMEYER RD.
FORT WAYNE IN
46815
US

IV. Provider business mailing address

4251 LAHMEYER RD.
FORT WAYNE IN
46815
US

V. Phone/Fax

Practice location:
  • Phone: 260-482-7800
  • Fax: 260-484-0273
Mailing address:
  • Phone: 260-432-4700
  • Fax: 260-459-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001840A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05011404A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: