MEDICARE: KENDRA P. HINES P.T.A.

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	2158	OK
2	225200000X	Physical Therapy Assistant	2108728	TX

General Provider Information

NPI Number	:	1811384357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA P. HINES P.T.A.

Provider Business Mailing Address
First Line	:	109 TURNBERRY LN
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-2065
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 WEST LOOP S STE 1525
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-3508
Country	:	US
Telephone Number	:	866-880-8010
Fax Number	:	886-965-9921

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

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	04/22/2015

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