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General NPI Number Information
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NPI Number | 1841793684
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Entity Type | Individual
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Provider Name | ALEXIS KENDRICK
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Gender | Female
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 1525 E BELTLINE AVE NE STE 203
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City | GRAND RAPIDS
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State | MI
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Zip | 49525
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Country | US
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Telephone | 616-734-0900
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Fax | 616-734-0890
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Provider Business Mailing Address
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Address Line | 6495 MCCORDS AVE SE
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City | ALTO
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State | MI
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Zip | 49302-9108
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Country | US
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Telephone | 706-325-6081
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501018155
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License Number State | MI
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