MEDICARE: LOUIS W KENDRICK P.T.

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	5501001795	MI

General Provider Information

NPI Number	:	1861640849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS W KENDRICK P.T.

Provider Business Mailing Address
First Line	:	655 WELLINGTON CRES
Second Line	:
City	:	MOUNT CLEMENS
State	:	MI
Zip	:	48043-2948
Country	:	US
Telephone Number	:	586-468-6171
Fax Number	:	586-468-1565

Provider Business Practice Location Address
First Line	:	1640 WEBB ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48206-1350
Country	:	US
Telephone Number	:	313-618-1041
Fax Number	:

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

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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