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General NPI Number Information
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NPI Number | 1447932835
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Entity Type | Individual
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Provider Name | KENDRA L. SMITH PTA
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Gender | Female
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 3920 W PARK AVE
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City | ORANGE
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State | TX
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Zip | 77630-1756
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Country | US
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Telephone | 409-920-4105
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Fax |
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Provider Business Mailing Address
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Address Line | 2909 N 118TH ST STE 200
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City | OMAHA
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State | NE
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Zip | 68164-3643
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Country | US
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Telephone | 402-509-5532
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Fax | 402-625-0417
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2097891
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License Number State | TX
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