Provider Demographics
NPI:1104230671
Name:PIERCE, KINDRA KAY (PTA)
Entity type:Individual
Prefix:
First Name:KINDRA
Middle Name:KAY
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KINDRA
Other - Middle Name:KAY
Other - Last Name:REINWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:1227 E 32ND ST STE 7
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2904
Practice Address - Country:US
Practice Address - Phone:417-624-7400
Practice Address - Fax:417-624-7403
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02644225200000X
MO2015000058225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant