MEDICARE: ADAM KENDIG PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2510	SC

General Provider Information

NPI Number	:	1619284643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM KENDIG PTA

Provider Business Mailing Address
First Line	:	638 E FLINTLAKE CT
Second Line	:	APT C
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-7543
Country	:	US
Telephone Number	:	716-474-4044
Fax Number	:

Provider Business Practice Location Address
First Line	:	3632 HAPPY WOODS COURT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579
Country	:	US
Telephone Number	:	843-293-2246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	09/13/2010

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