MEDICARE: DR. JESSICA HOLDER KENDALL PT, DPT

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	225100000X	Physical Therapist	P16079	NC

General Provider Information

NPI Number	:	1851757876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA HOLDER KENDALL PT, DPT

Provider Business Mailing Address
First Line	:	1130D SNOW BRIDGE LN
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-8411
Country	:	US
Telephone Number	:	336-904-0467
Fax Number	:	336-497-3072

Provider Business Practice Location Address
First Line	:	1130D SNOW BRIDGE LN
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-8411
Country	:	US
Telephone Number	:	336-904-0467
Fax Number	:

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

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	08/25/2020

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