Healthcare Provider Details

I. General information

NPI: 1902417496
Provider Name (Legal Business Name): KYNDALL JENNINGS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYNDALL KING

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 MAIN ST
AGAWAM MA
01001-2540
US

IV. Provider business mailing address

723 MAIN ST
AGAWAM MA
01001-2540
US

V. Phone/Fax

Practice location:
  • Phone: 844-570-5714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: